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

Distal Interphalangeal Joint Arthrodesis Complicated by Postoperative Infection: A Rare Presentation of Disseminated Herpes Simplex Virus.

Postoperative infection after elective arthrodesis of the interphalangeal joint is an uncommon complication often necessitating urgent debridement. We present the rare case of a female patient with a history of oral herpetic lesions, who underwent elective arthrodesis of the middle and index fingers for treatment of erosive osteoarthritis and subsequently developed a postoperative herpetic infection at the surgical site

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

A Formal Executable Semantics of Verilog

This paper describes a formal executable semantics for the Verilog hardware description language. The goal of our formalization is to provide a concise and mathematically rigorous reference augmenting the prose of the official language standard, and ultimately to aid developers of Verilog-based tools; e.g., simulators, test generators, and verification tools. Our semantics applies equally well to both synthesizeable and behavioral designs and is given in a familiar, operational-style within a logic providing important additional benefits above and beyond static formalization. In particular, it is executable and searchable so that one can ask questions about how a, possibly nondeterministic, Verilog program can legally behave under the formalization. The formalization should not be seen as the final word on Verilog, but rather as a starting point and basis for community discussions on the Verilog semantics.CCF-0916893CNS-0720512CCF-0905584CCF-0448501NNL08AA23Cunpublishedis peer reviewe

Partial Purification & Kinetic Studies of Nicotinamide Adenine Dinucleotide Phosphate-Specific Isocitrate Dehydrogenase of Phycomyces Blakesleeanus

The nicotinamide adenine dinucleotide phosphate -specific isocitrate dehydrogenase (threo-Ds(+) isocitrate: NADP+: oxidoreductase [decarboxylating]; E.C. 1.1.1.42.) of Phycomyces blakesleeanus was partially purified. The method used to purify the enzyme was a combination of protamine sulphate precipitation, ammonium sulphate fractionation, and ion exchange and gel filtration chromatography. The NADP+ -specific IDH was purified from an initial specific activity of 0.05 units/mg of protein to a final specific activity of 1.5 units/mg protein in solution. Molecular and reaction characteristics were explored. Employing gel filtration the molecular weight of the enzyme was determined to be 88,000. The forward reaction was found to have a pH optimum of 7.5 to 8.5. The pH optimum for the reverse reaction was found to be 6.0. Kinetic studies performed showed the apparent Km\u27s for Mn++. and threo-Ds(+) isocitrate to be 2.45 x 10-4 M, and 1.57 x 10-4 M, respectively. Apparent Km\u27s for Mn++ and NADPH in the reverse reaction were found to be: Mn++, 9.7 x 10-5 M, and NADPH, 1.52 x 10-4 M. Alpha-ketoglutarate did not give a linear Lineweaver-Burk plot. Hill plots for the reverse reaction showed the binding orders for Mn and NADPH to be 2 and 1, respectively

The summertime plankton community at South Georgia (Southern Ocean): comparing the historical (1926/27) and modern (post 1995) records.

The earliest comprehensive plankton sampling programme in the Southern Ocean was 32 undertaken during the early part of last century by Discovery Investigations to gain a 33 greater scientific understanding of whale stocks and their summer feeding grounds. An 34 initial survey was carried out around South Georgia during December 1926 and January 35 1927 to describe the distribution of plankton during the summer, and to serve as a 36 baseline against which to compare future surveys. We have reanalysed phytoplankton and 37 zooplankton data from this survey and elucidated patterns of community distribution and 38 compared them with our recent understanding of the ecosystem based on contemporary 39 data. Analysis of Discovery data identified five groups of stations with characteristic 40 phytoplankton communities which were almost entirely consistent with the original 41 analysis conducted by Hardy and Gunther (1935). Major groupings were located at the 42 western end of the island and over the northern shelf where Corethron spp. were 43 dominant, and to the south and east where a more diverse flora included high abundances 44 of Nitzschia seriata. Major zooplankton-station groupings were located over the inner 45 shelf which was characterised by a high abundance of Drepanopus forcipatus and in 46 oceanic water >500 m deep that were dominated by Foraminifera, Oithona spp., 47 Ctenocalanus vanus, and Calanoides acutus. Stations along the middle and outer shelf 48 regions to the north and west, were characterised by low overall abundance. There was 49 some evidence that groupings of stations to the north of the island originated in different 50 water masses on either side of the Southern Antarctic Circumpolar Current Front, the 51 major frontal system in the deep ocean close to South Georgia. However, transect lines 52 during 1926/27 did not extend far enough offshore to sample this frontal region 53 3 adequately. Interannual variability of zooplankton abundance was assessed from stations 54 which were sampled repeatedly during 7 recent British Antarctic Survey cruises (1995-55 2005) to the region and following taxonomic harmonization and numerical 56 standardization (ind. m-3), a subset of 45 taxonomic categories of zooplankton (species 57 and higher taxa) from 1926/27, were compared with similar data obtained during the 58 BAS cruises using a linear model. Initially comparisons were restricted to BAS stations 59 that lay within 40 km of Discovery stations although a comparison was also made using 60 all available data. Despite low abundance values in 1926/27, in neither comparison did 61 Discovery data differ significantly from BAS data. Calculation of the percentage 62 similarity index across cruises did not reveal any systematic differences in species 63 composition between 1926/27 and the present. In the light of ocean warming trends, the 64 existence of more subtle changes in species composition is not ruled out, but an absence 65 of finely resolved time-series data make this impossible to determine

Dynamics and Statics of Liquid-Liquid and Gas-Liquid interfaces on Non-Uniform Substrates at the Micron and Sub-Micron Scales

Droplets and bubbles are ubiquitous motifs found in natural and industrial processes. In the absence of significant external forces, liquid-liquid and gas-liquid interfaces form constant mean curvature surfaces that locally minimize the free energy of a given system subject to constraints. However, even for sub-micron bubbles and droplets free of hydrodynamic and hydrostatic stresses (small Capillary, Weber, and Bond numbers), non-equilibrium at the contact line of sessile bubbles and droplets can influence geometries and dynamics. First, the wetting of micron-sized ellipsoidal particles was considered. In the space of axially symmetric interfaces, it is found that multiple constant mean curvature surfaces can satisfy volume and contact angle constraints. Partial encapsulation may be preferred even when the droplet\u27s volume is sufficient to fully engulf the particle. The co-existence of multiple equilibrium states suggests possible hysteretic encapsulation behavior. Secondly, motivated by electron microscopy observations of sub-micron bubbles in a liquid cell, a small mobile and growing bubble confined between two weakly diverging plates is considered theoretically. Scaling analysis suggests that observed bubbles move by continuously wetting and de-wetting the substrates onto which they are adhered. 2D and 3D models are constructed incorporating the Blake-Haynes mechanism, which relates the dynamic contact angle to contact line velocity; partial pinning of the contact line is also considered. In 2D, the system is fully described by a set of non-linear ordinary differential equations that can be readily solved. In 3D, the non-linear PDE system and constraints were solved using a pseudo-spectral method. Both 2D and 3D models predict that in order for a doubly confined bubble to grow in a super-saturated solution it must first increase its curvature; this is in contrast to a free-floating bubble whose curvature always decreases with the addition of mass/volume. Since the surface concentration is proportional to the internal pressure of the bubble, this geometric change temporarily regulates the growth of the bubble. The model predicts growth rates like those observed experimentally that are several orders of magnitude lower than predictions made by classical mass transfer driven growth theory developed by Epstein and Plesset