Fighting Cybercrime After \u3cem\u3eUnited States v. Jones\u3c/em\u3e

In a landmark non-decision last term, five Justices of the United States Supreme Court would have held that citizens possess a Fourth Amendment right to expect that certain quantities of information about them will remain private, even if they have no such expectations with respect to any of the information or data constituting that whole. This quantitative approach to evaluating and protecting Fourth Amendment rights is certainly novel and raises serious conceptual, doctrinal, and practical challenges. In other works, we have met these challenges by engaging in a careful analysis of this “mosaic theory” and by proposing that courts focus on the technologies that make collecting and aggregating large quantities of information possible. In those efforts, we focused on reasonable expectations held by “the people” that they will not be subjected to broad and indiscriminate surveillance. These expectations are anchored in Founding-era concerns about the capacity for unfettered search powers to promote an authoritarian surveillance state. Although we also readily acknowledged that there are legitimate and competing governmental and law enforcement interests at stake in the deployment and use of surveillance technologies that implicate reasonable interests in quantitative privacy, we did little more. In this Article, we begin to address that omission by focusing on the legitimate governmental and law enforcement interests at stake in preventing, detecting, and prosecuting cyber-harassment and healthcare fraud

An Intelligent Data Mining System to Detect Health Care Fraud

The chapter begins with an overview of the types of healthcare fraud. Next, there is a brief discussion of issues with the current fraud detection approaches. The chapter then develops information technology based approaches and illustrates how these technologies can improve current practice. Finally, there is a summary of the major findings and the implications for healthcare practice

Finding Resources for Health Reform and Bending the Health Care Cost Curve

Examines policy options for slowing healthcare spending growth, improving outcomes, and financing comprehensive reform, including changes to Medicare Advantage and hospital pay-for-performance. Compares their estimated budget impact over ten years

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

Data Mining in Health-Care: Issues and a Research Agenda

While data mining has become a much-lauded tool in business and related fields, its role in the healthcare arena is still being explored. Currently, most applications of data mining in healthcare can be categorized into two areas: decision support for clinical practice, and policy planning/decision making. However, it is challenging to find empirical literature in this area since a substantial amount of existing work in data mining for health care is conceptual in nature. In this paper, we review the challenges that limit the progress made in this area and present considerations for the future of data mining in healthcare

Legislative responses to data breaches and information security failures

On July 23, 2008, the Payment Cards Center of the Federal Reserve Bank of Philadelphia hosted a workshop to discuss federal and state legislative responses to data breaches. The workshop addressed several laws and legislative initiatives designed to create greater safeguards for personal consumer information frequently targeted by data thieves and often subject to the failures of information security protocols. Diane Slifer, J.D., M.B.A., who has frequently presented at forums on data security and has represented clients in matters related to data breaches, led the workshop. Slifer examined several highly publicized data breaches and explained how various laws and regulations have been put in place in order to protect and inform consumers whose personal information has been compromised. Additionally, she discussed several legislative initiatives designed to potentially create a more structured and secure environment for private consumer data overall. This paper summarizes Slifer's presentation, the ensuing discussion, and additional Payment Cards Center research. In addition, it offers a brief overview of recent data breaches, a description of various ways that federal and state laws operate, and some thoughts on how effective these laws and regulations have been.Payment systems ; Identity theft ; Fraud ; Law and legislation

Adaptive Financial Regulation and RegTech: A Concept Article on Realistic Protection for Victims of Bank Failures

Frustrated by the seeming inability of regulators and prosecutors to hold bank executives to account for losses inflicted by their companies before, during, and since the financial crisis of 2008, some scholars have suggested that private-attorney-general suits such as class action and shareholder derivative suits might achieve better results. While a few isolated suits might be successful in cases where there is provable fraud, such remedies are no general panacea for preventing large-scale bank-inflicted losses. Large losses are nearly always the result of unforeseeable or suddenly changing economic conditions, poor business judgment, or inadequate regulatory supervision—usually a combination of all three. Yet regulators face an increasingly complex task in supervising modern financial institutions. This Article explains how the challenge has become so difficult. It argues for preserving regulatory discretion rather than reducing it through formal congressional direction. The Article also asserts that regulators have to develop their own sophisticated methods of automated supervision. Although also not a panacea, the development of “RegTech” solutions will help clear away volumes of work that understaffed and underfunded regulators cannot keep up with. RegTech will not eliminate policy considerations, nor will it render regulatory decisions noncontroversial. Nevertheless, a sophisticated deployment of RegTech should help focus regulatory discretion and public-policy debate on the elements of regulation where choices really matter

Immigration of Foreign Workers: Labor Tests and Protections

[Excerpt] Economic indicators confirm that the U.S. economy sunk into a recession in December 2007. Although some economic indicators suggest that growth has resumed, unemployment remains high and is projected to remain so for some time. Historically, international migration ebbs during economic crises; for example, immigration to the United States was at its lowest levels during the Great Depression. While preliminary statistical trends hint at a slowing of migration pressures, it remains unclear how the current economic recession will affect immigration. Addressing these contentious policy reforms against the backdrop of economic crisis sharpens the social and business cleavages and narrows the range of options. Some employers maintain that they continue to need the “best and the brightest” workers, regardless of their country of birth, to remain competitive in a worldwide market and to keep their firms in the United States. While support for increasing employment-based immigration may be dampened by the high levels of unemployment, proponents argue that the ability to hire foreign workers is an essential ingredient for economic growth. Those opposing increases in foreign workers assert that such expansions—particularly during a period of high unemployment—would have a deleterious effect on salaries, compensation, and working conditions of U.S. workers. Others question whether the United States should continue to issue foreign worker visas (particularly temporary visas) during a recession and suggest that a moratorium on such visas might be prudent. The number of foreign workers entering the United States legally has notably increased over the past decade. The number of employment-based legal permanent residents (LPRs) grew from under 100,000 in FY1994 to over 250,000 in FY2005, and stood at 166,511 in 2008. The number of visas issued to employment-based temporary non-immigrants rose from just under 600,000 in FY1994 to approximately 1.3 million in FY2007. In FY2009, the number of visas issued to employment-based temporary nonimmigrants dropped slightly to 1.1 million. The Immigration and Nationality Act (INA) bars the admission of any alien who seeks to enter the U.S. to perform skilled or unskilled labor, unless it is determined that (1) there are not sufficient U.S. workers who are able, willing, qualified, and available; and (2) the employment of the alien will not adversely affect the wages and working conditions of similarly employed workers in the United States. The foreign labor certification program in the U.S. Department of Labor (DOL) is responsible for ensuring that foreign workers do not displace or adversely affect working conditions of U.S. workers. The 111th Congress has addressed one element of the labor market test for foreign workers issue in §1611 of P.L. 111-5, the American Recovery and Reinvestment Act of 2009, which requires companies receiving Troubled Asset Relief Program (TARP) funding to comply with the more rigorous labor market rules of H-1B dependent companies if they hire foreign workers on H-1B visas. Also, §524 of division D of the Consolidated Appropriations Act, 2010 (P.L. 111-117) authorized the Department of Labor to use its share of the H-1B, H-2B, and L Fraud Prevention and Detection fees to conduct wage and hour enforcement of industries more likely to employ any type of nonimmigrants (not just H-1B, H-2B or L visaholders). This report does not track legislation and will be updated if policies are revised