Solutions: Workers' Compensation
SIGNIFICANT FRAUD LOSSES
Workers' compensation fraud is a serious problem for many states, as evidenced by the results of a survey conducted for the Bureau of Audits in California. Published in June 2008, the "Workers' Compensation Medical Payment Accuracy Study" estimates that more than 20% of total payments were "errors." Over $1 billion in payment errors were processed in a single year in California alone.
SOPHISTICATED SOLUTION
Infoglide Software's Identity Resolution EngineTM (IRE) addresses the three primary categories of workers' compensation fraud:
- Employee fraud
- Medical provider fraud
- Employer fraud
Often perpetrators of workers' compensation fraud alter their identity information (or that of their company) to avoid detection. IRE presents a unified view of individuals with multiple identities and uncovers hidden relationships between individuals including employees, medical providers, and/or employers.
The table below shows two different identities for the same person from two different data sources. Note that almost every attribute is different and would therefore not be identified as the same person by traditional systems, yet to a human being it is quite clear that these two identities are the same person. The similarity search and data matching capabilities of IRE are able to provide a scored result that indicates that these two identities are likely the same individual.
Identity Comparisons across Data Sources
| Attribute | Identity #1 | Score | Identity #2 |
|---|---|---|---|
| First Name | Michelle | 90% | Shelly |
| Last Name | O'Brian | 90% | OBryan |
| Company Name | HARMAN INTL. IND. INC. | 95% | HARMAN INTERNATIONAL INDUSTRIES, INC. |
| Street Address | 3550 Twisted Oak Drive | 93% | 3505 Twisting Oaks |
| City | Jacksonville | 85% | Jackson |
| State | Florida | 100% | FL |
| Zip Code | 35035 | 91% | 35305 |
| Passport ID | MY255909 | 77% | MJ225090 |
| License Plate | 510 B81 | 82% | SIO 13B |
| Eye Color | Hazel | 90% | Green |
| DOB | 4/11/56 | 92% | 11-4-1956 |
Note: Scores listed for illustration purposes only.
IRE can then determine what other identities or entities this individual is connected to. For example, the address in one of the records above might also be the address for a medical provider in a separate case.
IMPRESSIVE RETURN ON INVESTMENT
In their 2006 and 2007 Annual Fraud Reports to the Legislature, Washington State's Department of Labor and Industries (L&I) described their Return on Investment (ROI) through vigorous anti-fraud efforts. In 2006 L&I employer audits identified assessments totaling nearly $21 million, investigations of claimants prevented the loss of over $15 million, and medical provider reviews resulted in the collection of nearly $500,000 in improper billings. These figures represent a return of $10.20 for every $1 spent in anti-fraud efforts.
Infoglide Software's background in law enforcement, insurance fraud, and homeland security has given us the expertise to unearth suspicious people and companies in workers' compensation systems. Catching and convicting perpetrators of workers' compensation fraud delivers clear monetary benefits, punishes the bad guys, and provides value to law-abiding individuals and companies.
For more information on how identity resolution (AKA entity analytics) technologies can address workers' compensation fraud, download our white paper on "Fighting Workers' Compensation Fraud Using Identity Resolution."
