Koyal Private Training Group

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.

Since last fall, when Target and Neiman Marcus reported unauthorized access to payment-card data, the potential of identity theft has been consumers' minds. Thieves steal personal information, such as your name and address, Social Security number and date of birth, to commit fraud - for example, getting a loan in your name. The first line of attack is getting informed. The best source for information on how to protect yourself is the Federal Trade Commission, a federal agency whose mission is consumer protection and law enforcement. The FTC website at http://tinyurl.com/blbmymb provides a series of steps for those whose identity has been compromised, as well as preventive measures you can take to protect yourself. Next, contact one of the three national credit-reporting companies: Equifax (http://www.equifax.com, 800-525-6285); Experian (http://http://www.experian.com, 888-397-3742); or TransUnion (http://http://www.transunion.com , 800-680-7289). If your identity has been stolen, you'll want to place an "initial fraud alert" on your credit file to help prevent new accounts being opened in your name, according to Cliff O'Neal, spokesperson for TransUnion.

Dear Liz: I'm confused about paying down credit card debt. Some say to pay the lowest-balance cards first and others say the highest balance or the one with the highest interest. I have almost $16,000 on credit cards ranging from a $4,930 balance on a card with an 8.24% interest rate to $660 on a card with an 18% rate. Answer: Actually, the first question you should ask is "How much credit card debt do I have compared to my income?" If your balances equal half or more of your annual earnings, you may not be able to pay it all off. You should make appointments with a legitimate credit counselor (such as one affiliated with the National Foundation for Credit Counseling at http://www.nfcc.org) and a bankruptcy attorney (referrals from the National Assn. of Consumer Bankruptcy Attorneys at http://www.nacba.org). If your situation isn't that dire, the fastest way out of debt is to pay the minimums on your lower-rate cards and send as much money as possible to your highest-rate card. Once that's paid off, concentrate on paying off the next-highest-rate card, and so on. Some people instead like to target balances from smallest to largest to get a quicker feeling of victory, but you typically pay more in interest with that approach. Ranking credit card firms Dear Liz: My wife and I have had our bank's airline cards a long time, but we want to change because it's become almost impossible to cash in the miles. What I don't see in various card-comparison articles are ratings of the card issuers for customer service and fraud protection. Our bank has been quite good at both, but what about the other issuers? Answer: People are often unduly impressed when their credit card issuers contact them frequently about possibly fraudulent charges. The issuers are the only ones at risk in these situations, since under "zero liability" policies you can't be held responsible for bogus charges. Also, if their software were better, they might do a better job of separating legitimate f

LANCASTER - Local law enforcement officials say identity theft is a nightmare that can ruin its victims' lives. Unfortunately for Maryanne Sicat, of Lancaster, she is living that nightmare. "For the last three years, I've been trying to clean up my credit and fix my finances and rebuild financially because I had my identity taken and used at several places," she said. Sicat has received bills from stores and utility companies for goods and services she did not purchase. Also, she was buying a television in 2013 at a big-box store and her telephone number came up under the name of a California man. "One time is OK," Sicat said. "The second store makes you wonder. But then every single store that I went to Christmas shopping, it was the same thing. So that's why I started checking into it more." She has the name of the person she thinks is using her information but has no idea how the person got her phone number. So Sicat filed a complaint with the Federal Trade Commission and the Lancaster Police Department, and she has become another identity fraud statistic. The FTC said identity fraud is the top complaint it has dealt with in the past 13 years. It received 369,132 such complaints in 2012, or 18 percent of its total complaints. Identity fraud dwarfed complaints about debt collectors, which was in second place with 199,721, according to information the FTC provided. Fairfield County Sheriff Dave Phalen said there have not been a large number of identity fraud and identity theft cases locally. However, that is little consolation to Sicat and others like her. "Everything's on credit," she said. "So you can't do anything. You can't buy anything. It's embarrassing, and it's extremely frustrating because it makes me paranoid. I don't trust anybody." What is identity fraud? Detective James Nicolia, of the Fairfield County Sheriff's Office, said identity fraud is when a person uses another's identity for financial gain o

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

Since March 2007, federal investigators have uncovered more than $5 billion in Medicare fraud, but they suspect that might just be the tip of the iceberg. As the prolific bank robber Willie Sutton reportedly said of robbing banks - because that's where the money is - health care fraud has become a huge problem throughout the country. According to the U.S. De­part­ment of Justice, Geor­gia ranks 12th in investigations, seventh in the number of fraud cases and sixth in total recovered - almost $98.95 million in 2012. In the Southern District of Georgia, more than $27 million in restitution was collected last year in one of the country's largest Medicare fraud prosecutions in 2005 - The Bio-Med Plus in Savannah. In Augus­ta, optometrist Jeffrey Spon­sel­ler was sentenced Jan. 9 to 33 months in prison and ordered to pay $441,000 in restitution for bilking Medicare. Federal investigations into Medicare fraud have exploded in response to the problem, said David Stewart, who recently left the U.S. attorney's office where one of his duties was health care fraud coordinator. Medicare fraud affects everyone because Medicare has become the primary health care coverage for most Amer­i­cans when they turn 65, said Ken­neth Crowder, who recently left the U.S. attorney's office and joined Stewart in private practice. When Medicare coverage started in 1966, 19.1 million were enrolled. In 2013, that number was 43.5 million, according to the Centers for Medicare and Medicaid Services. With the last of the baby boomer generation turning 50 this year and increased health insurance coverage through the Affordable Care Act, Stew­art and Crowder said fraud is expected to expand. Going after health care fraud holds the promise of getting money back for the government, Stewart said, which is another reason the Jus­tice Department has set that as a top goal. The attack on those defrauding Medicare and military health care provider TriCare occurs in crimina

Som selskaper akseptere at det er en veldig reell fare for sine sikkerhetsinfrastruktur blir brutt, tildeling av IT-sikkerhet bruker er sette å endre, flytte fra forebygging fokus å innlemme gjenkjenning og svar. Med denne endringen i budsjett tildeling, er cyber forsikringer klar til å bli et effektivt verktøy i å håndtere stiger det sikkerhet kostnader. IT-sikkerhet bruker har tradisjonelt vært fokusert på forebygging, med de fleste bedrifter bruker så mye som 80% av sikkerhet budsjettet på forebyggende verktøy. Gjenkjenning og svar, samtidig som vanlige funksjonene på et budsjett, har vanligvis bare mottatt liten skiver av kaken, snitt på rundt 15% og 5% av samlede budsjettet bruke henholdsvis. Som sørafrikanske fortsetter å se en økning i antall cyber-angrep, begynner de å realisere og erkjenner at tradisjonell signaturbasert forebyggende tiltak er vanligvis feilbarlig. Akseptere at et brudd kan oppstå resulterer i økt fokus blir plassert på gjenkjenning og svar evner, er målet som å redusere tiden det tar å identifisere og reagere på et sikkerhetsbrudd. Dette skiftet i fokus er også tydelig i de nye løsningene blir undersøkt og utgitt av sikkerhetsleverandørene. "Dette er spennende tider - som big data konseptet fortsetter å modne, jeg tror sikkerhet og hendelsesovervåking vil bli revolusjonert, kombinere uensartede datakilder for utlede sammenheng og kjøre ned de tradisjonelle leveringstid har vi sett for å identifisere brudd, sier CyGeist MD, Natalie van de Coolwijk. Siste tallene viser gjennomsnitt nesten 200 dager for selskaper å oppdage brudd, godt over halvparten av firmaene blir varslet om brudd av en ekstern part. "Når introdusert, POPI krever obligatorisk brudd rapportering og varsel til berørte parter. Selskapene må identifisere og svare brudd raskt og effektivt for å beskytte deres omdømme. Rapportering 200 dager gamle brudd er aldri kommer til å bli lett,"advarer Van de Coolwijk. Det er forventet at i næ

Kongressen debatter utvide langsiktige dagpenger for noen 1,3 millioner amerikanere, tapt i oppvarmet retorikken er noen veldig viktige tall for skattebetalere. Stat og føderale arbeidsledighet forsikring systemet har hjulpet mange mennesker i nød, men det er også tillatt noen kvalifisert mottakere svikaktig hjelpe seg selv til lommebøker av bedrifter og skattebetalere. USA registrert noen $7,7 milliarder dollar i feil arbeidsledighet forsikring betalinger i 2013, ifølge US Department of Labor. Anslått urettmessig betaling går så høyt som 18.16 prosent i Nebraska. Louisiana postet den høyeste beregnede svindel satsen i landet i fjor, på mer enn 7 prosent. I Wisconsin: * Anslått urettmessig betaling utgjorde$ 92,644,556, gjennom 30 juni. Systemet hadde en anslått uriktig betalingen rate på 10.48 prosent, ifølge Labor Department. Prisen er summen av overbetaling rate og underbetaling rente, trekke overbetalinger gjenopprettet, for arbeidsledighet forsikring program for rapporteringsperioden. Dataene krever urettmessig betaling informasjon Act. * Majoriteten av urettmessig betaling involverer arbeid søk spørsmål - manglende evne til å validere at et individ har møtt Statens arbeidskrav søk- og inntekter foregående år, der en person fortsetter å kreve og få fordeler etter returnerer arbeide. * Den estimerte arbeidsledigheten forsikring svindel i perioden var 2,1 prosent. * Staten bestemt nesten 5600 fordringshavere mottatt falske føderale Emergency arbeidsledighetstrygd overbetalinger totalt $10.5 millioner mellom 1 januar 2013 og 30 november 2013. For bestemmelse er potensielle ankes, ifølge John Dipko, talsmann for staten avdelingen av arbeidsstyrke utvikling.