Electronic fraud detection in the U.S. Medicaid Healthcare Program: lessons learned from other industries

It is estimated that between $600 and$850 billion annually is lost to fraud, waste, and abuse in the US healthcare system,with $125 to$175 billion of this due to fraudulent activity (Kelley 2009). Medicaid, a state-run, federally-matchedgovernment program which accounts for roughly one-quarter of all healthcare expenses in the US, has been particularlysusceptible targets for fraud in recent years. With escalating overall healthcare costs, payers, especially government-runprograms, must seek savings throughout the system to maintain reasonable quality of care standards. As such, the need foreffective fraud detection and prevention is critical. Electronic fraud detection systems are widely used in the insurance,telecommunications, and financial sectors. What lessons can be learned from these efforts and applied to improve frauddetection in the Medicaid health care program? In this paper, we conduct a systematic literature study to analyze theapplicability of existing electronic fraud detection techniques in similar industries to the US Medicaid program

Process Framework for Subscriber Management and Retention in Nigerian Telecommunication Industry

in the global telecommunication industry. Hence, a dominant approach for subscriber management and retention is churn control, since it is cheaper to retain an existing subscriber than acquiring a new one. Predictive modeling employs the use of data mining techniques to identify patterns and provide a result that a group of subscribers are likely to churn in the near future. However, the effectiveness of subscriber retention strategy in an organization can be further boosted if the reason for churn and the timing of churn can also be predicted. In this paper, we propose a data mining process framework that can be used to predict churn, determine when a subscriber is likely to churn, provides the reason why a subscriber may churn, and recommend appropriate intervention strategy for customer retention using a combination of statistical and machine learning techniques. This experiment is carried out using data from a major telecom operator in Nigeria

Mining Target-Oriented Fuzzy Correlation Rules to Optimize Telecom Service Management

To optimize telecom service management, it is necessary that information about telecom services is highly related to the most popular telecom service. To this end, we propose an algorithm for mining target-oriented fuzzy correlation rules. In this paper, we show that by using the fuzzy statistics analysis and the data mining technology, the target-oriented fuzzy correlation rules can be obtained from a given database. We conduct an experiment by using a sample database from a telecom service provider in Taiwan. Our work can be used to assist the telecom service provider in providing the appropriate services to the customers for better customer relationship management.Comment: 10 pages, 7 table

Toward Universal Broadband in Rural Alaska

The TERRA-Southwest project is extending broadband service to 65 communities in the Bristol Bay, Bethel and Yukon-Kuskokwim regions. A stimulus project funded by a combination of grants and loans from the Rural Utilities Service (RUS), TERRA-Southwest has installed a middle-mile network using optical fiber and terrestrial microwave. Last-mile service will be through fixed wireless or interconnection with local telephone networks. The State of Alaska, through its designee Connect Alaska, also received federal stimulus funding from the National Telecommunications and Information Administration (NTIA) for tasks that include support for an Alaska Broadband Task Force “to both formalize a strategic broadband plan for the state of Alaska and coordinate broadband activities across relevant agencies and organizations.” Thus, a study of the impact of the TERRA project in southwest Alaska is both relevant and timely. This first phase provides baseline data on current access to and use of ICTs and Internet connectivity in rural Alaska, and some insights about perceived benefits and potential barriers to adoption of broadband. It is also intended to provide guidance to the State Broadband Task Force in determining how the extension of broadband throughout the state could contribute to education, social services, and economic activities that would enhance Alaska’s future. Results of the research could also be used proactively to develop strategies to encourage broadband adoption, and to identify applications and support needed by users with limited ICT skills.Connect Alaska. The National Telecommunications and Information Administration. General Communications Incorporated.Part 1: An Analysis of Internet Use in Southwest Alaska / Introduction / Previous Studies / Current Connectivity / Analytical Framework and Research Methodology / Demographics / Mobile Phones: Access and Use / Access to the Internet / Internet Useage / Considerations about Internet Service / Interest in Broadband / Sources of News / Comparison with National Data / Internet Use by Businesses and Organizations / What Difference may Broadband make in the Region? / Conclusiongs / Part 2 Literature Review / Reference

Income, work and education: insights for closing the gap in urban Australia

Existing analysis of the Closing the Gap outcomes is limited by the lack of adequate wage data for Indigenous Australians. This paper attempts to redress this situation by using a geography recently developed by the ABS - Significant Urban Areas - to document the crucial relationships between income, labour force status and education. Abstract: Many factors contribute to differences in an individual’s command over resources. One of the factors is differences in labour market engagement and the level of education attainment across different geographical areas. However, existing analysis of the Closing the Gap outcomes is limited by the lack of adequate wage data for Indigenous Australians. Using the newly introduced geography Significant Urban Areas (SUAs), which distinguish between major cities, regional centres and remote areas, this paper analyses average personal income while adjusting for labour force status and education levels. We impute average wage data by focusing on the personal income of people who are employed full-time and assuming that the average weekly personal income is a reasonable approximation of wages. The findings suggest that wage differences between Indigenous and non-Indigenous Australians in urban areas are minimal after education attainment levels are adjusted for, with a gradient in wages according to the level of qualification. There are gender differences in wages in favour of men, both across SUAs and by education level. This is partly a reflection of the structure of employment and segregation in the labour market, which can reach as high as 40 per cent in some the SUAs. Considering the importance of wage data in the theory of economic development, it is essential that direct information on wages is collected in future surveys with a substantial sample of Indigenous Australians

Returns to Human Capital under the Communist Wage Grid and During the Transition to a Market Economy

Under communism, workers had their wages set according to a centrally-determined wage grid. In this paper we use new micro data on men to estimate returns to human capital under the communist wage grid and during the transition to a market economy. We use data from the Czech Republic because it is a leading transition economy in which the communist grid remained intact until the very end of the communist regime. We demonstrate that for decades the communist wage grid maintained extremely low rate of return on education, but that the return increased dramatically and equally in all ownership categories of firms during the transition. Our estimates also indicate that men's wage-experience profile was concave in both regimes and on average it did not change from the communist to the transition period. However, the de novo private firms display a more concave profile than SOEs and public administration. Contrary to earlier studies, we show that men's inter-industry wage structure changed substantially between 1989 and 1996.http://deepblue.lib.umich.edu/bitstream/2027.42/39656/3/wp272.pd

A taxonomy of multi-industry labour force skills

This paper proposes an empirical study of the skill repertoires of 290 sectors in the United States over the period 2002–2011. We use information on employment structures and job content of occupations to flesh out structural characteristics of industry-specific know-how. The exercise of mapping the skills structures embedded in the workforce yields a taxonomy that discloses novel nuances on the organization of industry. In so doing we also take an initial step towards the integration of labour and employment in the area of innovation studies

Sectoral productivity and spillover effects of FDI in Latin America

Empirical studies analysing productivity effects of inward FDI in Latin America (LA) are inconclusive. We argue that investigating aggregate FDI masks interesting effects of FDI that take place within and across sectors. Moreover, the potential of FDI to generate productivity effects differs across sectors. For these reasons and because sectoral FDI intensities vary significantly among LA countries and change over time, we investigate the productivity effects of FDI in eight different sectors including the primary sector, manufacturing and services. Besides FDI, sector-specific institutional factors, education and a sector‘s export share are considered as control variables. Given the likely endogeneity of variables, a GMM system estimation approach is used. The results indicate that positive productivity effects can be found in all sectors, although they may depend on specific conditions or are limited to a certain time period. Direct productivity effects are highest in the primary sector (agriculture, mining and petroleum production) and in financial services. In contrast, FDI in manufacturing and in transport and telecommunications generates productivity spillovers to nearly all other sectors.FDI, productivity, sector level, Latin America