Group items tagged

FierceHealthPayer: Anti-Fraud: What are some early indicators SIUs can watch for signaling that reports of potential fraud, waste and abuse may become significant or urgent cases? Mike Little: Assessing allegations early is a challenge, but taking some specific and general steps can help SIUs determine if a case may become a priority. The first specific step is assessing the allegation. What's involved, and what's the scope of the issue? Could it be part of a larger problem or national scheme with the potential for media attention? Also check if patient safety is at risk. Financial harm at the expense of patients is an area that becomes urgent very quickly. And different case steps are necessary if patient safety issues are involved as opposed to financial issues alone. Are there signs that unlicensed individuals are at work? This can raise questions about your company's credentialing and due diligence processes that affect patient safety. And lastly, determine if employees from your organization may be implicated. That may cause reputational harm and indicate internal control weaknesses. But insurers and the federal government can no longer wait for complaints to arrive because often by then there's been significant loss. So SIUs should also take general steps to spot trends and risks. These steps involve knowledge. First, plug into a healthcare fraud task force. These exist nationwide and include other SIUs and federal and state law enforcers and regulators. These groups are the wave of the future in terms of public and private partnerships. There's a great deal of information shared about what's happening at other companies or in other segments of the community.

WASHINGTON - The numbers of affected consumers are as yet impossible to predict, but mortgage-credit experts warn that the recent massive data breaches at Target, Neiman Marcus and other retailers could have significant side effects on some real-estate transactions in the coming months, as damaged credit files depress scores and jeopardize loan applications and home sales. The Target breach alone could touch as many as 70 million credit- and debit-card customers, according to the company. Neiman Marcus says data on 1.1 million of its customers may be vulnerable to fraud. So what are the potential blowbacks on home sales and mortgage applications? Start with the basics. Identity theft, if not corrected quickly, can make a mess of anyone's credit-bureau files. Though victims may not be liable for the unauthorized debts racked up, their credit reports - and in turn their credit scores - can be damaged for weeks or months. Listen to Terry Clemans, executive director of the National Consumer Reporting Association, the primary trade group that represents independent credit-reporting companies serving the mortgage industry.

"Identity Thief" is a 2013 movie starring Jason Bateman and Melissa McCarthy about a woman who steals the identity of a man named "Sandy." After the McCarthy character steals the Bateman character's identity, all types of high-jinx ensue. In real life, identity fraud is a very serious matter that frequently ruins the credit of the victim and takes a great deal of time and effort to resolve. With the 2013 tax filing season starting on January 31, 2014, the season for tax identity fraud is also upon us. Stolen identity refund fraud (SIRF) is a subset of identity theft that involves the criminal stealing the tax "identity" of an individual. Similar to any identity fraud, a criminal committing tax identity fraud obtains key information about the victim. In the tax context, the key is obtaining the individual's name matched with his or her social security number. Once that is obtained, the SIRF thief submits a false tax return in the name of the victim claiming a tax refund. Unfortunately, in many instances the refunds are issued. The fraud may be discovered when the unsuspecting victim files his or her own return and discovers that the IRS will not issue a refund because a return has already been filed under their social security number. It can be very difficult for the individual to get this straightened out with the IRS once the tax identity theft has been committed. Like other identity theft, tax identity theft frequently causes the victim a number of problems including damaging credit ratings, and reducing state or federal benefits. The victims of tax identity fraud are frequently the elderly, or individuals collecting subsistence payments who are not required to file federal income tax returns. For the elderly and those who are not required to file tax returns, it may take much longer for such individuals to discover that they were victims of tax identity fraud. Nevertheless, the fraud may impact those individuals by reducing state or