Using Benford\u27s Law to Detect Fraud in the Insurance Industry

Benford\u27s Law is the mathematical phenomena that states that the first digits or left most digits in a list of numbers will occur with an expected logarithmic frequency. While this method has been used in industries such as oil and gas and manufacturing to identify fraudulent activity, it has not been applied to the health insurance industry. Since health insurance companies process a large number of claims each year and these claims are susceptible to fraud, the use of this method in this industry is appropriate. This paper examines the application of Benford\u27s Law to four health insurance companies located in the Midwest. For each company, analysis was performed on the first digit distribution, the first two-digit distribution, and providers with high volumes of claims. The results show that the populations are similar to the frequencies predicted by Benford\u27s Law. The findings also suggested possible fraudulent activity by specific providers, however, the companies determined that these results occurred due to abnormal billing practices and were not fraudulent. The insurance companies that participated in this study will continue to use this method to further detect fraudulent claims

Internal Auditor Participation in Systems Development Projects

There are differing viewpoints in the internal auditing literature regarding the role of internal audit in systems development projects. One argument is that internal audit should act as consultants for such projects. A counter argument is that if internal auditors act as consultants this could impair in dependence. This study surveyed chief audit executives to determine their perceptions of the role of internal audit in systems development projects as well as the actual involvement of their departments in such projects. The findings show that chief audit executives place more importance on internal audit acting as consultants and less importance on independence in these projects. The results also suggest that internal audit has limited involvement in the different phases of the Systems Development Life Cycle of these projects

A MOSAIC of methods: Improving ortholog detection through integration of algorithmic diversity

Ortholog detection (OD) is a critical step for comparative genomic analysis of protein-coding sequences. In this paper, we begin with a comprehensive comparison of four popular, methodologically diverse OD methods: MultiParanoid, Blat, Multiz, and OMA. In head-to-head comparisons, these methods are shown to significantly outperform one another 12-30% of the time. This high complementarity motivates the presentation of the first tool for integrating methodologically diverse OD methods. We term this program MOSAIC, or Multiple Orthologous Sequence Analysis and Integration by Cluster optimization. Relative to component and competing methods, we demonstrate that MOSAIC more than quintuples the number of alignments for which all species are present, while simultaneously maintaining or improving functional-, phylogenetic-, and sequence identity-based measures of ortholog quality. Further, we demonstrate that this improvement in alignment quality yields 40-280% more confidently aligned sites. Combined, these factors translate to higher estimated levels of overall conservation, while at the same time allowing for the detection of up to 180% more positively selected sites. MOSAIC is available as python package. MOSAIC alignments, source code, and full documentation are available at http://pythonhosted.org/bio-MOSAIC

Going-Concern Opinions: Broadening the Expectations Gap

A rash of high-profile bankruptcies has led to a search for answers. Many hold auditors responsible for not detecting the potential for bankruptcy during the most recent audit. The Weiss Report, a study of several dozen bankrupt companies submitted to the U.S. Senate during its deliberations on the Sarbanes-Oxley Act, found a broad and massive failure on the part of auditors to raise yellow flags that indicate potential bankruptcy. The authors examined Weiss\u27 methodology and found that, applied to a broader group of companies, Weiss\u27 criteria would have incorrectly predicted bankruptcy for nearly half of the non-bankrupt companies studied. This failure to accurately predict undermines the credibility of the subsequently enacted legislation

Representation results for defeasible logic

The importance of transformations and normal forms in logic programming, and generally in computer science, is well documented. This paper investigates transformations and normal forms in the context of Defeasible Logic, a simple but efficient formalism for nonmonotonic reasoning based on rules and priorities. The transformations described in this paper have two main benefits: on one hand they can be used as a theoretical tool that leads to a deeper understanding of the formalism, and on the other hand they have been used in the development of an efficient implementation of defeasible logic.Comment: 30 pages, 1 figur

Continuous repetition rate tuning with timing window independent self-seeding of a gain-switched Fabry-PÉrot Laser

In this work, we propose a novel self-seeding technique that yields timing window independent operation allowing continuous repetition rate tuning of the self-seeded gain-switched (SSGS) laser. This is achieved by employing a highly linearly chirped fiber Bragg grating (LC FBG) as a wavelength selective element. The reflected gain-switched pulses are dispersed to such an extent, that temporal overlap occurs between them. This overlap creates a pseudo continues wave like signal that is re-injected into the gain-switched laser