fraud

Bass, Berry & Sims Releases Healthcare Fraud & Abuse Review 2019

The annual Review examines key issues in healthcare fraud enforcement and the False Claims Act and highlights the need for healthcare companies to continue to enhance compliance efforts.(PRWeb February 19, 2020)Read the full story at https://www.prweb.com/releases/bass_berry_sims_releases_healthcare_fraud_abuse_review_2019/prweb16913994.htm

Chargebacks911 Warns Consumer Fraud Threatens Retailers’ BOPUS Boom

The ability to buy something online and pick it up in a store, increasingly popular with consumers, will soon be offered by most U.S. big-box retailers. Loss prevention specialist Chargebacks911 warns that an expected increase in fraud could lessen the model’s profitability.(PRWeb February 17, 2020)Read the full story at https://www.prweb.com/releases/chargebacks911_warns_consumer_fraud_threatens_retailers_bopus_boom/prweb16914872.htm

HashCash Partners with Global Food Manufacturer to Fight Food Fraud

Blockchain technology offers the ultimate solution to global food manufacturers to track their food products across the supply chain, ensuring zero cases of food fraud. Our project will also ensure that food is being produced and distributed safely

PALO ALTO, Calif. (PRWEB) February 14, 2020
HashCash Consultants, extend their Blockchain expertise to a US-based Global food production and distribution company to build a transparent, traceable and immutable supply chain network. The idea originated from the mutual goal of both parties to ensure food safety and prevent counterfeit food products from entering the supply chain.
Talking about this venture with the media, Raj Chowdhury, CEO of HashCash Consultants commented, “Blockchain technology offers the ultimate solution to global food manufacturers to track their food products across the supply chain, ensuring zero cases of food fraud. Our project will also ensure that food is being produced and distributed safely and sustainably. Such accountability within the system will strengthen the bond of trust between manufacturers and consumers.”
Issues with the Food Supply Chain
Food fraud is an age-old concern within the industry that has been one of the hardest to counter. Time and again people have expressed concern over the authenticity and quality of food products such as cheese, edible oils, coffee, honey, milk, seafood, spices, etc. The present-day consumers need quality assurance against the food which is being sourced, produced and distributed safely and sustainably to prevent potential health hazards.
Tracking of the food items during its transit from the fields to the grocers is equally essential for swift crisis management in case of any contamination.
Coming to the third and the most concerning issue – the counterfeiting of food products entering the food supply chain is a major discrepancy which leads to substantial losses every year. All these highlight the major lags within the existing supply chain management that needs a quick fix.
How HashCash Proposes to Optimize the Food Supply Chain?
Blockchain technology augments the legacy system with a unified approach towards monitoring and tracking of the food supply chain right from the fields to the manufacturing/packaging units and finally to the retailers.
The HashCash collaboration aims at bringing traceability and transparency into the partner company’s supply chain. Every detail concerning production, packaging, and distribution of the products will be entered and recorded in the shared immutable ledger. The ledger will also have details on how the raw materials are being sourced to ensure the safety and sustainability of the entire process.
The use of smart contracts between participants will further validate the process and prevent any unauthorized activity.    
The end food products will have a QR code, scanning which the consumer will be able to access all essential details regarding the food sourcing and manufacturing.
About HashCash Consultants
HashCash is a global software company. HashCash Blockchain products enable enterprises to move assets and settle payments across borders in real-time for Remittances, Trade Finance, Payment Processing and more. HashCash runs US-based digital asset exchange, PayBito & digital asset payment processor, BillBitcoins. HashCash offers cryptocurrency exchange and payment processor software solutions, ICO services and customized use cases. HashCash propels advancement in technology through Blockchain 1o1 programs and its investment arm, Satoshi Angels. HashCash offers solutions in AI, Big Data and IoT though its platforms, products & services. HashCash solves the toughest challenges by executing innovative digital transformation strategies for clients around the world.

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Tokyo-Based Phybbit, Ltd. Releases 2020 Ad Fraud Survey Report for Japan

Analysis Reveals Slight Decrease in Online Ad Fraud Between First Half and Second Half of 2019 – Believed to Be Attributed to Phybbit’s ‘Shared Blacklist,’ an Industry-Wide Consolidated Database of Scam Affiliates
Press Release – updated: Feb 5, 2020 11:00 EST

TOKYO, February 5, 2020 (Newswire.com) – Tokyo-based Phybbit, Ltd., developer of SpiderAF anti-advertising fraud software, has released its annual “2020 Ad Fraud Survey Report” covering Japan. The company analyzed over 924 billion impressions, 66 billion clicks and 115 million conversions to create the industry’s most comprehensive snapshot of online advertising fraud. 
According to Phybbit’s analysis of the Japanese market, out of 20 million mobile installs in the six months between July and December 2019, 3.3 million installs, or approximately 16.7%, were found to be fraudulent. At a rate of $5 USD per install, the resulting damage would be $16.5 million during this six-month period. In the previous analysis (January to June 2019), the percentage of ad fraud cases has slightly decreased. This decrease can be attributed to the implementation of Phybbit’s Shared Blacklist (SBL), a unique industry-wide consolidated database of scammers identified by Phybbit’s powerful SpiderAF algorithm. The SBL is shared with all ad networks in Japan to create a unified front against advertising cheats.
“According to our findings in this 2019 analysis, it is becoming clear that ad fraud methods are getting more sophisticated every year,” said Phybbit, Ltd., CEO Satoko Ohtsuki. “Particularly with ad fraud used in app advertising, their methods can change over fast cycles. Algorithms that were effective six months ago quickly become outdated and useless. In order to detect it, it’s necessary to analyze the data from multiple angles.”     
Methods used by ad fraudsters include Click Flooding, Install Hijacking, Invalid Traffic and Click Farms. SpiderAF detects ad fraud by analyzing data logs for impressions, clicks, and conversions. Each action is analyzed for signs of ad fraud and an overall ad fraud score is calculated using AI.  
For more details on the findings, download here. 
About SpiderAF
SpiderAF is an AI-equipped ad fraud tool specialized in automation and data visualization. Along with businesses involved with ad networks, SpiderAF aims to be a tool applicable to a wide variety of users from agencies to advertisers. The goal of the SpiderAF SHARED BLACKLIST is to build a safer digital advertising industry.
About Phybbit, Ltd.
Phybbit is the developer and provider of the automated, AI-driven fraud prevention tool SpiderAF. Phybbit’s team of data scientists is working to help fight the ever-evolving issue of ad fraud. Founded on the belief that the happiness of each team member must be realized to fully support the company, Phybbit is committed to creating a “work-life integration” corporate environment that allows people to live their lives in their own way by promoting more flexible work lifestyles.
Source: Phybbit, Ltd.

Highmark Inc.’s Anti-Fraud Department using Artificial Intelligence to reduce fraud, waste and abuse impact

“By using technology and working with other Blue Plans and law enforcement, we have continually evolved our processes and are proud to be among the best nationally.” -Melissa Anderson, executive VP and chief audit and compliance officer, Highmark Health

PITTSBURGH (PRWEB) February 03, 2020
Highmark Inc.’s Financial Investigations and Provider Review (FIPR) department made a financial impact of over $260 million in savings related to fraud, waste and abuse in 2019 and has saved more than $850 million over the past five years. In 2020, FIPR is successfully using artificial intelligence (AI) to enhance the company’s ability to identify, prevent and stop potentially fraudulent activities earlier than ever.
“We know the overwhelming majority of providers do the right thing. But we also know year after year millions of health care dollars are lost to fraud, waste and abuse,” said Melissa Anderson, executive vice president and chief audit and compliance officer, Highmark Health. “By using technology and working with other Blue Plans and law enforcement, we have continually evolved our processes and are proud to be among the best nationally.”
Kurt Spear, vice president of financial investigations and provider review for Highmark Inc., said AI is a game-changer for everyone.
“Highmark’s Payment Integrity program deploys twenty eight unique initiatives to help ensure claims payment accuracy. Fifteen of these initiatives are embedded within our FIPR department and aim directly at addressing instances of fraud, waste and abuse. Healthcare claims go through rigorous reviews, including automated AI algorithms as well as manual assessments,” he said. “Although just recently implemented, we’re already seeing positive results from our AI software. The goal of AI is to adapt quickly to changing behavior and to help predict aberrancies earlier than traditional tools that often rely on established rules to catch suspicious behavior. We know it is much easier to stop these bad actors before the money goes out the door then pay and have to chase them.”
Spear said these very sophisticated tools are looking at algorithms and patterns to detect indicators of fraudulent activity much sooner than in the past. He noted that as bad actors use social media and other tools and evolve their schemes, Highmark also leverages best practices to limit financial exposure for our customers. As further noted below, the results of Highmark’s anti-fraud department continue to be recognized as industry leading.
Here is a chart of the savings from 2015 – 2019.
Year     Actual Savings2015: $120,000,0002016: $148,000,0002017: $183,000,0002018: $145,000,0002019: $260,000,000
Breaking down 2019, Spear said the $260 million in financial impact includes prevented losses, recovered money and policy savings.
FIPR utilizes an internal team that includes registered nurses, investigators, accountants, former law enforcement agents, clinical coders and programmers, complemented by an array of industry-leading vendors, to complete its objectives. As part of its work, the team performs audits to identify unusual claims, coding reviews and investigations that assess the appropriateness of provider payments.
National Independent External ReviewRecently national healthcare industry consultant Change Healthcare conducted an assessment of Highmark Inc.’s Payment Integrity programs, including FIPR. The goal of the assessment was to determine how Highmark’s Payment Integrity programs compare with other large Blues plans and national insurers and to identify any areas for improvement. The independent external review showed that Highmark’s work is among the best in the nation. The program outpaces the industry standard and saves approximately ten percent of medical claims for group customers. The program also delivers nearly 33 percent more savings than other national payers.
“We have known for some time that our programs have substantial return on investment and were top notch. This external review proves that we are among the best in the nation, and that means real savings for our Highmark regional and national customers,” added Jeff Bernhard senior vice president of national and commercial markets, Highmark Inc. “This is also a benefit to our Sales teams when out competing to win business. They can share this information with our prospective customers and truly benchmark Highmark, and show it superiority around fraud and waste controls, compared to other insurance carriers.”
National AwardsIn late 2019, Highmark’s Financial Investigations and Provider Review (FIPR) department was honored by the National Health Care Anti-Fraud Association (NHCAA) with the Special Investigation Resource and Intelligence System (SIRIS) Investigation of the Year award. This is considered among the top awards in the nation. The investigation involved a specialty pharmacy supplying excessive amounts of hemophilia factor medications to patients. In order to drive up their reimbursement, the pharmacy would create shell employer groups that would enroll as an ACA small group. Ultimately, the scheme was shut down.
NHCAA also recognized Highmark with a second award for Excellence in Public Awareness for Highmark’s Opioid Epidemic Education Program.
“The goal of our program is to educate students, facilitators and parents about the opioid epidemic. The presentation to students, faculty and parents addresses understanding opioids, fentanyl, heroin and deadly drug combinations, being empowered to say “no”, the stigma of addiction and key takeaways for real-life situations. Highmark has reached more than 8,500 students and plans to continue the program in 2020,” Spear said.
ABOUT HIGHMARK INC.One of America’s leading health insurance organizations and an independent licensee of the Blue Cross Blue Shield Association, Highmark Inc. (the Health Plan) and its affiliated health plans (collectively, the Health Plans) work passionately to deliver high-quality, accessible, understandable, and affordable experiences, outcomes, and solutions to customers. As the fourth-largest overall Blue Cross Blue Shield-affiliated organization, Highmark Inc. and its Blue-branded affiliates proudly cover the insurance needs of more than 4.4 million members in Pennsylvania, Delaware, and West Virginia. Its diversified businesses serve group customer and individual needs across the United States through dental insurance and other related businesses. For more information, visit http://www.highmark.com.
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Approaches and Priorities for Fighting Faster Payments Fraud

One of the 3 exhibits included in this research report

As financial institutions are wrestling with new fraud types and the rise of tactics like business email compromise, they are rolling out new faster payments solutions that innately allow less time to detect criminal activity. The good news is that security providers are responding with solutions.

BOSTON (PRWEB) January 27, 2020
Financial institutions are implementing or planning new faster payment solutions from same day to real-time transactions and creating roadmaps for new products with faster payment solutions embedded. Simultaneously, attention is being given to protecting faster transactions and preserving the trust customers have in their banks and credit unions to protect their financial transactions. A new research report from Mercator Advisory Group titled Faster and Real-Time Payments Fraud reviews these trends, challenges, and solutions.
“At the same time that financial institutions are wrestling with new fraud types and the rise of tactics like business email compromise, they are rolling out new faster payments solutions that innately allow less time to detect criminal activity. The good news is that the security providers are responding with solutions. The implementation and adaptation of these solutions to individual operating environments needs to be the focus,” comments Sarah Grotta, Director, Debit and Alternative Products Advisory Service at Mercator Advisory Group and author of the report.
Highlights of the research report include:
Mercator Advisory Group’s forecast for faster payments adoption by channel
Discussion of the unique challenges of faster payments fraud and a look at challenges experienced in the United Kingdom, where real-time payments have been available for over a decade
Evolving fraud capabilities including account ID and verification, account validation, analytics and artificial intelligence
Mention of vendors advancing faster payment fraud mitigation tools
Beyond the technology solutions, potential laws and policies that will influence liability for faster payment
This research report has 15 pages and 3 exhibits.
Companies and other organizations mentioned in this report include: ACH Alert, Brighterion, Early Warning, Experian, Faster Payments Service (U.K.), Feedzai, Federal Reserve, FICO, GIACT, LexisNexis, Mastercard, NICE Actimize, NuData Security, Rambus, RiskRecon, The Clearing House, Verafin, and Visa
Members of Mercator Advisory Group’s Debit and Alternative Products Advisory Service have access to these reports as well as the upcoming research for the year ahead, presentations, analyst access, and other membership benefits.
For more information and media inquiries, please call Mercator Advisory Group’s main line: 1-781-419-1700, send email to info@mercatoradvisorygroup.com.
For free industry news, opinions, research, company information and more visit us at http://www.PaymentsJournal.com.
Follow us on Twitter @ http://twitter.com/MercatorAdvisor.
About Mercator Advisory GroupMercator Advisory Group is the leading independent research and advisory services firm exclusively focused on the payments and banking industries. We deliver pragmatic and timely research and advice designed to help our clients uncover the most lucrative opportunities to maximize revenue growth and contain costs. Our clients range from the world’s largest payment issuers, acquirers, processors, merchants and associations to leading technology providers and investors. Mercator Advisory Group is also the publisher of the online payments and banking news and information portal PaymentsJournal.com.

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