FraudCast
Welcome to the Pondera FraudCast, where we post information on fraud trends, lessons learned from client engagements, and observations from our investigators in the field. We hope you’ll check back often to stay current with our efforts to combat fraud, waste, and abuse in large government programs.
Ugly Case of Health Care Fraud
By Jon Coss, CEO
July 27, 2016A few weeks ago, I published a blog post titled “Money Obtained Fraudulently is Rarely Used for Good Purposes”. In it, I made the argument that government fraud is a serious, and at times very ugly problem. Now I no longer have to make that argument because the United States Justice Department is making the […]
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The False Positive Problem
By Jon Coss, CEO
July 19, 2016Last year, 60 Minutes did a segment on the impact of errors in the Social Security Administration’s Death Master File—a database that stores dates of death for Americans. The system stores 86 million records, and despite all best efforts, it still has some issues. 60 Minutes pointed out that errors in the system contribute to […]
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Pondera’s High Potential Leader: Amanda Huston
By Amanda H., Chief Customer Officer
July 5, 2016Established in 1636, Harvard University is the United States’ oldest institution of higher learning and one of the world’s most prestigious universities. A couple of weeks ago, I had the remarkable opportunity to participate in the Harvard Business School Executive Education Program for High Potential Leaders. To step foot on this amazing campus filled with […]
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Provider Screening and Program Integrity in Medicaid Managed Care
By Jon Coss, CEO
June 13, 2016Medicaid expenditures have nearly doubled over the last decade [1] and states have increasingly looked to a capitated reimbursement model utilizing managed care organizations (MCO) to ensure continued access to quality health care services. The Centers for Medicare and Medicaid Services (CMS) estimate that roughly 80% of all Medicaid recipients currently receive healthcare services via […]
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Learning from Antivirus Software
By Jon Coss, CEO
May 27, 2016Almost everyone is familiar with antivirus software. Not everyone is familiar with how it works though. Even fewer have examined how we can apply the way antivirus software works to combat fraud. I believe that there are important lessons here which can improve our approach to fraud detection and prevention. At a high level, antivirus […]
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Money Obtained Fraudulently is Rarely Used for Good Purposes
By Jon Coss, CEO
May 16, 2016People often ask me if I think we can make a difference fighting fraud by stopping down-on-their-luck Americans from grabbing a few extra bucks that they are not entitled to from government programs. In fact, many people ask if it’s even the right thing to do. After all, they explain, wouldn’t anyone do the same […]
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The Internet Changes Everything
By Jon Coss, CEO
April 22, 2016Way back in 2006, I read an article in the Harvard Business Review that described how the Internet had changed the sales profession. One key observation dealt with the “de-coupling” of the sales cycle from the buying cycle. Prior to the Internet, buyers had to contact vendors for information on their products. Today, buyers do […]
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Binary Nature of Fraud
By Jon Coss, CEO
April 14, 2016Big data analytics and the predictive engines they spawned give Internet companies a way to monetize the online experience. By tracing online behavior, companies can target advertising, promotions, and point of sale opportunities based upon past buying decisions. Online habits of Web users can be associated with ideologies, interests, and values. Increasingly sophisticated probability engines […]
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SaaS Procurement Recommendations
By Jon Coss, CEO
March 24, 2016This week, my company is responding to an RFP for SaaS fraud detection services. While we are thankful for the opportunity to respond, the RFP and its process also illustrates the need for governments to adjust their procurement processes with the advent of cloud computing. After all, we responded to the RFI for this procurement […]
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The Problem With Knowing What You Know
By Jon Coss, CEO
March 10, 2016I bet you cna’t bvleiee taht you can uesdtannrd waht you are rdnaieg. Unisg the icndeblire pweor of the hmuan mnid, aocdcrnig to rseecrah at Cmabrigde Uinervtisy, it dseno’t mttaer in waht oderr the lterets in a wrod are, the olny irpoamtnt tihng is taht the frsit and lsat ltteer be in the rhgit pclae. […]
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