When the Centers for Medicare & Medicaid Services (CMS) announced its vision to modernize Medicare program integrity, Administrator Seema Verma highlighted the agency’s interest in seeking new innovative strategies involving machine learning and artificial intelligence.
Executive Order Directs HHS to use AI to Detect Fraud and Abuse
The announcement came earlier this month and followed an Executive Order by President Trump which urged the Secretary of Health and Human Services (HHS) to direct “public and private resources toward detecting and preventing fraud, waste, and abuse, including through the use of the latest technologies such as artificial intelligence.”
Medicare Fraud Estimated between $21 and $71 Billion Annually
Medicare fraud, waste, and abuse costs CMS and taxpayers billions of dollars.
Artificial intelligence and machine learning could be more cost effective and less burdensome, and can help existing predictive systems designed to flag fraud.
HHS Among Largest Data Producers in the World
In order to understand the potential for AI, CMS also recently issued a Request for Information asking, among other things, if AI tools are being used in the private sector to detect fraud and how AI can enhance program integrity efforts.
But the promise of AI isn’t in just in the CMS data. It’s also in the behaviors of those looking to commit fraud.
According to Jeremy Clopton, director at accounting
consultancy Upstream Academy and an Association of Certified Fraud Examiners
faculty member, the risk of fraud is often described as having three key factors: a perceived pressure
or financial need, a perceived opportunity, and a rationalization of the
“Every online communication between
traffickers, ‘johns,’ and their victims reveals potentially actionable
information for anti-trafficking investigators.”
The study noted the potential for integrating human experts and computer-assisted technologies like AI to detect trafficking online.
AI and human trafficking
Similar research conducted at Carnegie Mellon University looked at how low-level traffickers and organized transnational criminal networks used web sites like Craigslist and Backpage to advertise their victims. The researchers developed AI-based tools to find patterns in the hundreds of millions of online ads and help recover victims and find the bad actors.
The conference brought together researchers, policy makers, social scientists, members of the tech community, and survivors.
One of those researchers – from Lehigh University – is working on a human trafficking project to help law enforcement overcome the challenges of turning vast amounts of data, primarily from police incident reports, into actionable intelligence to assist with their investigations.
Providing better alerts and real risks
Former Federal government officials share the optimism about the power of AI to aid law enforcement in weeding out the criminals and finding the victims.
example, law enforcement can look at young women of a certain age entering the
country from certain high-risk jurisdictions. Marry that up with social media
and young people missing from home, or people associated with a false
employment agency or who think they are getting a nanny job, and you start to
develop a complete picture. And the information can be brought up all at once,
rather than an analyst having to go through the Dark Web.”
To report suspected human trafficking to Federal law enforcement, call 1-866-347-2423.
To get help from the National Trafficking Hotline call 1-888-373-7888 or text HELP or INFO to BeFree (233733).
about AI-powered Radiance and its risk sensing capabilities for issues like human trafficking.
And, according to the Coalition
Against Insurance Fraud, 2018 was the third consecutive time in six years that
insurers reported increasing amounts of fraud. Nearly three-quarters of
insurers reported that fraud had increased either significantly or slightly, an
11-point increase since 2014.
To address this issue the Coalition’s survey reinforced
Genpact’s findings: nearly two-thirds of insurers planned to acquire new
technology in the next year for enhanced detection of claims fraud, and another
one-third would add technology to address underwriting fraud.
Deloitte further notes that among the areas that will see the greatest impact are fraud detection and risk analysis. Beyond these important use cases, AI and machine learning assist with customer due diligence, augmenting existing processes with analysis of external data sources.
Transformation to ‘Predict and Prevent’
The power of AI, according
to experts, is its ability to analyze mass amounts of data from a wide
range of sources including previous claims, customer information, and social
media, to help combat fraud.
A senior data scientist at AXIS Capital recently
noted that 80 percent of internal data is unstructured in the form of PDF
and emails, and that AI’s text mining and natural language processing could
help reveal core hidden information.
Additionally, she pointed to AI’s ability to scrape
information from the Internet, gathering information in real time to understand
With these capabilities, AI can transform the industry, and underwriting in particular, into the ‘predict and prevent’ mode.
McKinsey recommends that as insurers onboard these technologies, they take a multi-pronged strategy that begins with getting smart on AI-related technologies and trends and includes the development and implementation of long-term technology plan.
Comprehensive Data Strategy
The firm also underscores that AI technology performs best with a high volume of data from multiple sources, and that carriers must develop a comprehensive data strategy. Internal data will need to be organized in ways that enable and support the agile development of new analytics insights and capabilities. With external data, carriers must focus on securing access to data that enriches and complements their internal data sets.
The Radiance Solution
Radiance is a powerful tool to help identify potential fraud and other concerns. It ingests and processes large amounts of unstructured data, providing actionable, prioritized results that can be further refined by entering publicly-available identifiable information.
Radiance’s deep web
listening goes beyond traditional social media monitoring tools, using
internally-developed and proprietary algorithms to capture online content
relevant to insurance fraud.
Radiance can apply the same machine learning capabilities against existing legacy databases, integrating those disparate sources and analyzing that data against risk and other industry specific needs.
A 2018 report by the United Nations
Office of Counter-Terrorism outlined the most intuitive physical threats to
critical infrastructure, including the energy sector, involved the use of
explosives or incendiary devices, rockets, MANPADs, grenades and tools to
That same report noted that the energy sector has witnessed sustained terrorist activity through attacks perpetrated by Al Qaeda and its affiliates on oil companies’ facilities and personnel in Algeria, Iraq, Kuwait, Pakistan, Saudi Arabia and Yemen.
Increasing Intensity of DDoS Attacks
In addition to physical threats, it is estimated that by 2020, at least five countries will see foreign hackers take all or part of their national energy grid offline through Permanent Denial of Service (PDoS) attacks. And, DDoS attacks like those in the Ukraine are becoming increasingly severe. Studies show that the number of total DDoS attacks decreased by 18 percent year-over-year in Q2 2017. At the same time, there was a 19 percent increase in the average number of attacks per target.
U.S. is the “Holy Grail”
of the U.S. power grid is considered the “holygrail,” and experts predict that the
energy industry could be an early battleground, not only the power sector, but
the nation’s pipelines and the entirety of the supply chain.
In fact, last year the Department of Homeland Security (DHS) and the Federal Bureau of Investigation (FBI) publicly accused the Russians of cyberattacks on small utility companies in the United States. In a joint Technical Alert (TA), the agencies said Russian hackers conducted spear phishing attacks and staged malware in the control rooms with the goal of gathering data to create detrimental harm to critical U.S. infrastructure.
900 “Vulnerabilities” Found in the
U.S. Energy Systems
This specific incident aside, DHS’s Industrial Control System Computer Emergency Response Team found nearly 900 cyber security vulnerabilities in U.S. energy control systems between 2011 and 2015, more than any other industry. It’s not surprising that the international oil sector alone is increased investments on cyber defenses by $1.9 billion in 2018.
Investment in Physical Security Will Reach $920 billion
With any disruption to the global or national energy supply having serious implications for virtually all industries, especially critical ones like healthcare, transportation, security, and financial services, one report projects that the global critical infrastructure protection market will be worth $118 billion by 2028.
Physical security is expected to account for the highest proportion of spending, and cumulatively will account for $920 billion in investment.
Artificial Intelligence: A Security “Pathway” for the Future
Experts suggest that these investments should include next generation technologies for both physical and cyber security purposes. As one expert put it: “Automation, including via artificial intelligence, is an emerging and future cyber security pathway.”
In addition to the role that automation, artificial intelligence and machine learning can bring to identifying and predicting a physical or cyber attack, research shows that it can also help manage the rising costs associated with it. A study found that only 38 percent of companies are investing in this technology – even though after initial investments, it could represent net saving of $2.09 million.
Learn more about AI-driven Radiance and how it can help identify and predict physical and cyber threats to the energy infrastructure.
While these high-profile incidents grab international headlines, the reality is that every organization is vulnerable to insider threats. On average, insider threats cost almost $9 million, take more than two months to contain and include issues related to careless workers, disgruntled employees, workplace violence and malicious insiders.
As part of National Insider Threat Awareness Month this September, the National Counterintelligence and Security Center (NCSC) is reminding companies of the need for strong insider threat protection programs and the signs to look for with existing employees.
Look for These Concerning Behaviors
William Evanina, who heads up NCSC, shares that those individuals engaged or contemplating insider threats display “concerning behaviors” before engaging in these events.
financial difficulty or unexplained extreme change in finances; and
job performance problems.
Early Detection Technologies
The Center suggests deploying solutions for monitoring
employee actions, correlating information from multiple data sources, having
tools for employees to report concerning or disruptive behavior, and monitoring
And, a report from Accenture found that while advanced identification, security intelligence and threat sharing technologies are widely adopted, automation, AI and machine learning are now being used by about 40 percent of companies.
Costs Savings from AI Automation
According to the same report, once investment costs are considered, AI automation could offer the highest net savings of about $2 million and begin to address the shortage in skilled security staff.
Following the Common Sense Guide to Mitigating Insider Threats
Companies looking to follow the CERT National Insider Threat Center’s guidelines, should consider how the Radiance platform can help with monitoring social media, correlating disparate information, and providing a tool for employees to report concerning behaviors.
OS-INT monitors all publicly available information across the entire deep
web, not only social media. And, it can
ingest massive amounts of unstructured content from disparate internal data
sources for further correlation and verification.
HUM-INT platform, known as S4, is a mobile application that allows users to
confidentially report concerns in real time.
It can be configured as a workplace tool, with a centralized management
portal to allow clients to access real–time threats to geo-fenced facility
As the summer draws to a close and students return to campus, schools across the country are incorporating active shooter response training into their procedures and protocols. The drills are just one component of overall safety preparedness efforts, being undertaken at the state, federal and local levels.
STRONG Ohio Plan Includes Social Media Scans
While response trainings on school campuses have become an increasingly common practice, the focus is even more pronounced in light of the recent mass shooting attacks in Dayton and El Paso.
In response to the shootings in Ohio, Governor Mike DeWine unveiled his STRONG Ohio plan, designed to reduce gun violence. The state created a School Safety Center, which will review school emergency management plans and offer risk threat and safety assessments, consolidate school safety resources on saferschools.ohio.gov, promote the use of a tip line to anonymously report suspected threats and scan social media and websites to identify people suggesting acts of violence.
Increased Arrests for Threatening Comments
Increased precautions aren’t just being taken at schools, and for good reason. Following those tragic events, the FBI ordered a new threat assessment to thwart future mass attacks in the country.
Be Prepared: Take notice of surroundings and identify potential emergency exits. Be aware of unusual behaviors and report suspicious activities to security or law enforcement.
Take Action: If an attack occurs, run to the nearest exit and conceal yourself while moving away from the dangerous activity. If you can’t exit to a secure area, protect yourself by seeking cover.
Assist and React: Call 9-1-1, remain alert and stay aware of the situation. Help with first aid when it is safe, and follow instructions once law enforcement arrives.
Part of your preparation can include downloading for free Lumina’s See Something Say Something app. It’s a crowd-sourced, mobile application that allows users to confidentially report concerns in real time.
You can learn more about S4 and download it here. It’s one part of our comprehensive, AI-driven risk management platform, Radiance.