When the Sopranos met Big Data (and lost)

Some of the pre-Glee generation may remember the hit HBO series ‘the Sopranos’. I recently came across this clip and it cracked me up. It shows a couple of thugs who try to shake down a Starbucks-like coffee outlet, only to hit the wall. The “little guy” being driven out of business is the local goon. Was David Chase prescient or what? [Caution: Clip contains crude language which may be…

Things to consider when fighting collusion fraud

Editor’s note: An abridged version of this article appeared as a web exclusive in Claims Magazine (http://claimsmag.com) on Oct 11, 2009. North American companies have developed sophisticated processes and technology to detect claims fraud. There are a variety of analytical techniques to use against claims data, such as automated red flags, predictive modeling, rules based analysis, data mining and others. At the most basic level, companies use decision rules to…