Hello-my-name-is1Posted by Douglas Wood, Editor.

Alright everybody, let’s play a game. The name game!

“Shirley, Shirley bo Birley. Bonana fanna fo Firley.
Fee fy mo Mirley. Shirley!”

No, not THAT name game. (Admit it… you used to love singing the “Chuck” version, though.)

The name game I’m referring to is slightly more sinister, and relates to the criminal intent to deceive others for gain by slightly misrepresenting attributes in order to circumvent fraud detection techniques. Pretty much anywhere money, goods, or services are dispensed, folks play the name game. Utilities, Insurance, Medicaid, retail, FEMA. You name it.

Several years ago, I helped a large online insurance provider determine the extent to which they were offering insurance policies to corporations and individuals with whom they specifically did not want to do business. Here’s what the insurer knew:

They had standard application questions designed to both determine the insurance quote AND to ensure that they were not doing business with undesirables. These questions included things such as full name, address, telephone number, date of birth, etc… but also questions related to the insured property. “Do you live within a mile of a fire station?”, Does your home have smoke detectors?”, and “Is your house made of matchsticks?”

On top of the questions, the insurer had a list of entities with whom the knew they did not want to do business for one reason or another. Perhaps Charlie Cheat had some previously questionable claims… he would have been on their list.

In order to circumvent the fraud prevention techniques, of course, the unscrupulous types figured out how to mislead the insurer just enough so that the policy was approved. Once approved, the car would immediately be stolen. The house would immediately burn down, etc.

The most common way by which the fraudsters misled the insurers was a combination of The Name Game and modifying answers until the screening system was fooled.

Through a combination of investigative case management and link explorer / link analysis software, I went back and looked at several months of historical data and found some amazing techniques used by the criminals. Specifically, I found one customer who made 19 separate online applications – each time changing just one attribute or answer slightly – until the policy was issued. Within a week of the policy issue, a claim was made. You can use your imagination to determine if it was a legitimate claim. :D

This customer, Charlie Cheat (obviously not his real name), first used his real name, address, telephone number, and date of birth… and answered all of the screening questions honestly. Because he did not meet the criteria AND appeared on an internal watch list for having suspicious previous claims, his application was automatically denied.

Then he had his wife, Cheri Cheat, complete the application in hopes that the system would see a different name and approve the policy. Thirdly, he modified his name to Charlie Cheat, Chuck E. Cheat, and so on. Still no go. His address went from 123 Fifth Street to 123-A 5th Street. You get the picture.

Then he began to modify answers to the screening questions. All of a sudden, he DID live within a mile of a fire station… and his house was NOT made of matchsticks… and was NOT located next door to a fireworks factory. After almost two dozen attempts, he was finally issued the policy under a slightly revised name, a tweak in his address, and some less-than-truthful answers on the screening page.

By investing in powerful  investigative case management software with link analysis and fuzzy matching – such as that provided by industry leader Xanalys Limited - this insurer was able to dramatically decrease the number of policies issued to known fraudsters or otherwise ineligible entities. Every time a new policy is applied for, the system analyzes the data against previous responses and internal watch lists in real time.  In other words, Charlie and Cheri just found it a lot more difficult to rip this insurer off.

These same situations occur in other arenas, costing us millions annually in increased taxes and prices.

So, what happened to the Cheats after singing the name game?  Let’s just say that after receiving a letter from the insurer, Charlie and Cheri started singing a different tune altogether.

Douglas Wood:

This week’s financial crimes headlines…

Originally posted on Byrnes' Tax & Wealth Management Blog:

Banca Privada d’Andorra Money Laundering Billions for Corruption and Human Traffickers?
FinCEN’s action also describes the activity of a second high–level manager at BPA in Andorra who accepted exorbitant commissions to process transactions related to Venezuelan third–party money launderers. This activity involved the development of shell companies and complex financial products to siphon off funds from Venezuela’s public oil company Petroleos de Venezuela (PDVSA). BPA processed approximately $2 billion in transactions related to this money laundering scheme.
Former Managing Director of RBS Securities Admits To Multimillion Dollar Securities Fraud of RBS Customers
Katke was a registered broker-dealer and managing director at RBS Securities Inc. As part of the scheme, Katke and his co-conspirators made misrepresentations to induce buying customers to pay inflated prices and selling customers to accept deflated prices for CLO bonds, all to benefit RBS.Commerzbank Admits to Sanctions and Money Laundering Violations, Will Pay $1.45 Billion Penalties!

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WASHINGTON, DC and ATLANTA (January 6, 2015) – LexisNexis® Risk Solutions today announced its intent to acquire BAIR Analytics, a provider of analytics solutions for public safety.  LexisNexis is acquiring BAIR Analytics to better provide the public safety community with comprehensive investigative solutions that aid them in their law enforcement mission.  BAIR Analytics deploys strong technology, robust analytics, mapping, and visual tools to identify and predict patterns of crime.  The transaction is subject to regulatory review.

“The acquisition of BAIR Analytics builds on LexisNexis’ commitment to public safety, providing us the ability to combine BAIR Analytic’s analytical capabilities with our public records and linking technology to add context to crime patterns and enhance our ability to identify and locate persons of interest,” said Haywood Talcove, chief executive officer, LexisNexis Special Services, Inc.  “The acquisition will be unique in the industry and help public safety officers make better decisions to close cases faster and improve community safety.  In an era of constrained budgets, analytics are essential to optimize limited resources and increase overall efficiencies.”

BAIR Analytic’s analytical tools have been used by large and small public safety organizations worldwide for more than 20 years to help reduce and prevent criminal activity.

“Becoming part of LexisNexis will bring new opportunities to expand and build the best possible solutions to help our public safety customers,” said Sean Bair, President, BAIR Analytics.   “BAIR Analytic’s ability to help agencies identify, analyze and resolve problems created by criminal offenders will be an exceptional complement to LexisNexis, its proven solutions and vast public records database to offer a more complete view of individuals to accelerate the investigation process.”

About LexisNexis Risk Solutions

LexisNexis Risk Solutions (http://www.lexisnexis.com/risk) is a leader in providing essential information that helps customers across all industries and government assess, predict and manage risk.  Combining cutting-edge technology, unique data and advanced analytics, LexisNexis Risk Solutions provides products and services that address evolving client needs in the risk sector while upholding the highest standards of security and privacy.  LexisNexis Risk Solutions is part of Reed Elsevier, a world leading provider of professional information solutions.

BAIR Analytics

Established in 1997, BAIR Analytics (http://www.bairanalytics.com) is an analytical software and services company providing innovative tools and subject-matter expertise for public safety, private security, and national security and defense entities. Nearly half of the largest public-safety agencies in the United States use BAIR Analytic’s products & services to fight crime.  BAIR Analytic’s current software tools are utilized by police departments, government agencies, and throughout the private sector worldwide to increase and promote smarter, community-oriented preventative policing.

# # #

Media Contact

Stephen Loudermilk
LexisNexis Risk Solutions
678.694.2353
stephen.loudermilk@lexisnexis.com

The WordPress.com stats helper monkeys prepared a 2014 annual report for this blog.

Here’s an excerpt:

A New York City subway train holds 1,200 people. This blog was viewed about 5,500 times in 2014. If it were a NYC subway train, it would take about 5 trips to carry that many people.

Click here to see the complete report.

Posted by Douglas Wood, Editor.

NOTE: This article originally appeared HERE by Jane Antonio. I think it’s a great read…

Link analysis has become an important technique for discovering hidden relationships involved in healthcare fraud. An excellent online source, FierceHealthPayer:AntiFraud, recently spoke to Vincent Boyd Bryant about the value of this tool for payer special investigations units.

A former biometric scientist for the U.S. Department of Defense, Bryant has 30 years of experience in law enforcement and intelligence analysis. He’s an internationally-experienced investigations and forensics expert who’s worked for a leading health insurer on government business fraud and abuse cases.

How does interactive link analysis help insurers prevent healthcare fraud? Can you share an example of how the tool works?

Boyd Bryant: Link analysis is most often used to piece together different kinds of data from multiple sources–to identify key players, connections between those players and patterns of behavior frequently missed. It can simplify an understanding of the level of involvement of individuals and criminal organizational hierarchies and can greatly simplify visualizing and communicating the operations of complex criminal enterprises.

One thing criminals do best is hide pots of money in different places. As a small criminal operation becomes successful, it will often expand its revenue streams through associated businesses. Link analysis is about trying to figure out where all those different baskets of revenue may be. Insurers are drowning in a sea of theft. Here’s where link analysis becomes beneficial. Once insurers discover a small basket of money lost to a criminal enterprise, then serious research needs to go into finding out who owns the company, who they’re associated with, what kinds of business they’re doing and if there are claims associated with it.

You may find a clinic, for example, connected to and working near a pharmacy, a medical equipment supplier, a home healthcare services provider and a construction company. Diving into those companies and what they do, you find that they’re serving older patients for whom multiple claims from many providers exist. The construction company may be building wheelchair ramps on homes. And you may find that the providers are claiming payment for dead people. Overall, using this tool requires significant curiosity and a willingness to look beyond the obvious.

Any investigation consists of aggregating facts, generating impressions and creating a theory about what happened. Then you work to confirm or disconfirm your theory. It’s important to have tools that let you take large masses of facts and visualize them in ways that cue you to look closer.

Let’s say you investigate a large medical practice and interview “Doctor Jones.” The day after the interview, you learn through link analysis that he transferred $11 million from his primary bank account to the Cayman Islands. And in looking at Dr. Jones’ phone records, you see he called six people, each of whom was the head of another individual practice on whose board Dr. Jones sits. Now the investigation expands, since the timing of those phone calls was contemporaneous to the money taking flight.

Why are tight clusters of similar entities possible indicators of fraud, waste or abuse?

Bryant: When you find a business engaged in dishonest practices and see its different relationships with providers working out of the same building, this gives rise to reasonable suspicion. The case merits a closer look. Examining claims and talking to members served by those companies will give you an indication of how legitimate the operation is.

What are the advantages of link analysis to payer special investigation units, and how are SIUs using its results?

Bryant:  Link analysis can define relationships through data insurers haven’t always had, data that traditionally belonged to law enforcement.

Link analysis results in a visual reference that can take many forms: It can look like a family tree, an organizational chart or a time line. This reference helps investigators assess large masses of data for clustering and helps them arrive at a conclusion more rapidly.

Using link analysis, an investigator can dump in large amounts of data–such as patient lists from multiple practices–and see who’s serving the same patient. This can identify those who doctor shop for pain medication, for example. Link analysis can chart where this person was and when, showing the total amount of medication prescribed and giving you an idea of how the person is operating.

What types of data does link analysis integrate?

Bryant: Any type of data that can be sorted and tied together can be loaded into the tool. Examples include telephone records, addresses, vehicle information, corporate records that list individuals serving on boards and banking and financial information. Larger supporting documents can be loaded and linked to the charts, making cases easier to present to a jury.

Linked analysis can pull in data from state government agencies, county tax records or police records from state departments of correction and make those available in one bucket. In most cases, this is more efficient than the hours of labor needed to dig up these types of public records through site visits.

Is there anything else payers should know about link analysis that wasn’t covered in the above questions?

Bryant: The critical thing is remembering that you don’t know what you don’t know. If a provider or member is stealing from the plan in what looks like dribs and drabs, insurers may never discover the true extent of the losses. But if–as a part of any fraud allegation that arises–you look at what and who is associated with the subject of the complaint, what started as a $100,000 questionable claims allegation can expose millions of dollars in inappropriate billings spread across different entities.

Published by Douglas Wood, Editor.

They say that imitation is the sincerest form of flattery. That said, Xanalys Limited is flattered by the growing number of vendors who are marketing their “Incident Management” software or Case Management Frameworks (CMFs, which are really just repackaged Business Process Management frameworks) as real Investigative Case Management and/or Major Case Management solutions.

Incident MXanTrianagement is not Investigative Case Management; noting an unlocked door in a warehouse is not akin to investigating major crimes. “Frameworks” are also not Investigative Case Management; they are instead the building blocks to a custom-built, multi-year deployment tied to long Professional Services engagements.

Only Investigative Case Management software is Investigative Case Management, and only Xanalys ‘ configurable COTS software is purpose-built for the three-legged stool of:

  1. Case Triage
  2. Investigation Analytics, and
  3. Process and Adjudication.

Today, many technology buyers in industries beyond government, legal and insurance are thinking about their work as case-oriented rather than simply transactional. That makes sense, as the investigation of criminal cases is neither strictly routine, nor completely ad hoc. Instead, investigations are a unique situation that involves complex interactions between content, people, and business or regulatory policies to achieve an optimal outcome. Designing a software application to address the needs of this unstructured process style is challenging, and as a result many vendors simply fall short.

While this new vendor market for case management solutions attempts to differentiate CMFs, the reality is that the strategy fails miserably when that delicate balance between flexibility and process must be reached. Incidents can become cases. Cases can become major cases.

According to Gartner Group, there are 11 Critical Capabilities for Investigative Case Management. Only the powerful, flexible COTS software provided by the leading investigation software companies meet all of the criteria:

  1. Supports a broad range of content types and content interaction services
  2. Supports a broad range of collaboration services to facilitate individual and group interactions among all case participants
  3. Interoperates well with other external content and process services
  4. Provides vertical and horizontal-specific data models, nomenclature, hierarchies and case life cycle management
  5. Provides application adapters to industry and domain-specific environments
  6. Provides comprehensive and configurable role-based user experience
  7. Provides business-role-friendly dashboards, metrics, and reporting
  8. Supports a broad range of case orchestration, from highly structured to highly adaptive flows
  9. Has been proven in deployments with 100,000 cases or more annually
  10. Provides intelligent and versatile on-ramps and off-ramps
  11. Leverages models for easy adaptability of the solution

While the highly touted generic frameworks and up-reaching incident management tools provide some of these capabilities, only true investigative case management software hits the bulls-eye.

The imitators may eventually get here, but for now, Xanalys – The Investigation Software Company – is the one true choice for major case management and investigation analytics.

San Diego, CA (September 28, 2014) ‐ Xanalys Limited, The Investigation Software Company, today announced an international distribution partnership with TriTech Software Systems. TriTech, the leading provider of public safety software, will market the Xanalys Link Analysis and Investigation Management tools to complement their industry-leading suite of applications for law enforcement agencies.

Under the terms of the agreement, TriTech customers can implement the industry-leading Xanalys Link Explorer software optimized for Law Records Management, Jail, and other Public Safety Data. The software is designed to help analysts and investigators find and visualize hidden links between elements in the data.

“As we looked to grow our distribution network within law enforcement, our search began and ended with TriTech,” said Xanalys VP Douglas Wood. “Their software suite is second to none, and their market strategy aligns perfectly with Xanalys’ vision. We’re looking forward to helping their customers solve more cases, more quickly through our combined offerings.”

“The power of Xanalys’ Link Analysis solutions, when combined with the investigative tools and rich big data stored in the TriTech Public Safety Suite creates a strong and compelling solution for investigators and analysts alike,” said Scott MacDonald, Senior Director of Product Management for TriTech. “

The announcement was made during TriCON, TriTech’s annual user conference in San Diego.

About TriTech Software Systems
TriTech Software Systems has been developing innovative solutions for public safety for more than 20 years. The company provides products and services to address any size and type agency with an end-to-end product suite to meet the needs of any agency – PSAP, Law, Fire, or EMS.

TriTech Software Systems’ sole focus is public safety software. The company’s experienced team contributes on average, 13 years of industry experience. TriTech has delivered the most trusted public safety software for over two decades and continues to lead the market with innovative, enterprise-wide cloud-based and on-premise solutions for 911, computer aided dispatch, records management, jail management, analytics and intelligence, field-based reporting, patient care reporting, and ambulance billing software.

For the best end-to-end integrated solution with unparalleled workflow, join the 2,700+ agency installations serving over 200 million citizens across 7 countries who rely on one company – TriTech Software Systems.

About Xanalys Limited
Xanalys Limited’s investigation software was born out of Cambridge, England technology company Harlequin in the late 1980s. The company’s software provides powerful querying facilities to support the effective analysis of disparate data that can actually identify links between contacts and reveal associations among activities that are not immediately apparent to an investigator or analyst.

The company’s products include Link Explorer, the powerful desktop investigation tool, and PowerCase, the leading Major Case Management software solution in the world. Xanalys also develops and markets investigative case management and link visualization software for its customers around the world.

With offices across the U.K., Canada, The United States, and Australia, Xanalys is one of the fastest growing and most well-respected investigation software companies in the world.

Posted by Douglas Wood, Editor.  http://www.linkedin.com/in/dougwood. Mr. Wood is VP, The Americas at Xanalys LimitedThe Investigation Software Company.

A brief read and good perspective from my friend Chris Westphal of Raytheon. The article is by Anna Forrester of ExecutiveGov.com.

Federal managers should invest in technology that would help them extract insights from data and base their investment decision on the specific problems and information they want to learn and solve, Federal Times reported Friday.

Rutrell Yasin writes that the above managers should follow three steps as they seek to compress the high volume of data their agencies encounter in daily tasks and to derive value from them.

According to Shawn Kingsberry, chief information officer for the Recovery Accountability and Transparency Board, federal managers should first determine the questions they need to ask of data then create a profile for the customer or target audience.

Next, they should locate the data and their sources then correspond with those sources to determine quality of data, the report said. “Managers need to know if the data is in a federal system of records that gives the agency terms of use or is it public data,” writes Yasin.

Finally, they should consider the potential impact of the data, the insights and resulting technology investments on the agency.

Yasin reports that the Recovery Accountability and Transparency Board uses data analytics tools from Microsoft, SAP and SAS and link analysis tools from Palantir Technologies.

According to Chris Westphal, director of analytics technology at Raytheon, organizations should invest in a platform that gathers data from separate sources into a single data repository with analytics tools.

Yasin adds that agencies should also appoint a chief data officer and data scientists or architects to assist the CIO and CISO on these areas.

Posted by Douglas Wood, Editor.  http://www.linkedin.com/in/dougwood

I’m delighted to have an investigation analytics article published in the Law Enforcement Investigation Units (LEIU) 2014 publication.  Click HERE to review via the LEIU website.

LEIU

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Altrincham, Cheshire, UK (PRWEB) May 12, 2014

Xanalys Limited today announced the immediate availability of its industry leading PowerCase XIM investigative case management software in a Software-as-a-Service (SaaS) deployment model. PowerCase software is the leading major case management (MCM) platform for multi-jurisdiction crime and fraud investigations. The company’s enterprise versions of the software are widely deployed in the U.K., the United States, Australia, and Canada, and sits as the core MCM investigation tool at the Ontario Ministry of Community and Correctional Services. This deployment is regarded worldwide as the flagship implementation of investigative case management technology, with over sixty jurisdictions utilizing the solution to collaborate and investigate major crimes across the province.

“The PowerCase XIM SaaS offering is a customer-driven initiative,” said Douglas Wood, VP, The Americas & Global Corporate Development at Xanalys. “Our clients, including law enforcement, state and local government services, and large commercial organizations can expect to see a reduced time to benefit, lower initial costs, and reduced infrastructure costs with the SaaS offering.”

“Xanalys’ SaaS offering is deployed via a network of strategic hosting partners, each of whom have been vetted for security and privacy compliance,” added Xanalys Managing Director Greg Mann. “The Xanalys SaaS offering is extremely secure and allows users to investigate and solve more cases, more quickly.”

PowerCase XIM includes patented functionality for major case management, link analysis, data indexing, text analytics, and evidence preparation.

The company said that PowerCase XIM SaaS allows organizations to quickly implement and utilize the software without large upfront licensing fees, and with less strain on IT. The SaaS offering is currently being deployed at several end-user locations, and the company expects to issue further announcements on the product next quarter.

About Xanalys Limited
Xanalys is a rapidly growing, privately held company that specializes in developing powerful software for threat assessment, investigative case management, and advanced crime and fraud analytics. The company’s products help clients manage multi-jurisdiction investigations, assess and analyze suspicious financial transactions, capture and act upon intelligence, and disclose evidence in a court-ready format to ensure successful adjudications.

Aside  —  Posted: May 12, 2014 in Investigation Software, Link Analysis, SaaS
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