Social
Media, Collusion, TMI and more!
Investigators utilize a
combination of tools and resources to gather intelligence on potential
subjects. The Internet adds another level of research accessible from any
computer with an Internet connection. While Internet research can
help obtain knowledge quickly, it can also contain false or misleading
information. It is up to each investigator to vet the source and the
details obtained. So how can the Internet help us to be better
investigators?
Connecting the dots
Many investigations result
in the identification of collusion among various actors.
Payers often rely on claims records and other internal databases to identify
relationships among suspects. However, those files may not contain all of
the attributes needed to connect the dots between individuals and organizations
working together to commit potential FWA. There
are a number of services (some for a fee) that offer public record and
background reports revealing individuals with shared addresses, phone numbers
and more. These sites can be very useful in identifying the
full network of potential suspects.
There are a number of FWA
schemes involving phantom providers, kickbacks from providers to members to use
the member's identity for billing, kickbacks between rendering and referring
providers and more. Some FWA systems such as PostShield™
incorporate features such as Link Analysis and external data sources to help
identify potential relationships between providers and members.
Rapport building
How often do you see
individuals putting a little too much information (TMI) out there about
themselves? We've all seen the typical TMI situation, right?
Investigators benefit from this TMI as it provides insight into both suspects
and witnesses character, you learn their likes and dislikes and can use this
information when building a rapport. Their interests can of
course also provide valuable insight into other areas of your investigation as
well.
Peek a boo
Individuals often pop up
on social media through tweets, Facebook, pictures, videos and
more. Through these various outlets, an investigator often
can identify physical locations, physical descriptions, and discrepancies in
claims. For example, over the years the media has reported many insurance
fraud related articles concerning individuals claiming they lost something such
as jewelry. Weeks later, that same individual posted a picture of
themselves with the jewelry they allegedly went missing. Social
media can be used to identify who knows who, where you are located, when you
are going somewhere, who you are with at that moment and so much more.
As with any investigation
for your organization, please ensure you are following your company's policies
and procedures on the use of social media and the Internet.
Does your FWA system
integrate external data, social media and other information from the web?
If not, contact Healthcare Fraud Shield
for more information.
If you have any questions,
you may email our Subject Matter Experts at SIU@hcfraudshield.com.