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16Feb
By Michael Skiba The Psychology of Fraud - Part 1
16 February 2016

- Why Do Fraudsters Commit Fraud Over Other Types of Crime? 

 

This article will infuse criminological theory into the fraud environment in order to assist with counter fraud efforts. Enjoy this 2-part article to be continued in the next newsletter! In this first section, we will dive into criminological theories, learning about the concepts and principles regarding criminal behavior. Next week, we will learn how all of this can be applied in an insurance fraud setting.   

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28Oct
By Tim Rush Technically Speaking: Fighting Medical Billing Fraud
28 October 2015

- As insurance experts and subscribers to this newsletter I would believe that you are familiar with terms related to medical billing such as ICD, CPT, HCFA, CMS, EHR, EOB, and the AMD. But what you may not be familiar with is the technology that gives a medical billing or claims fraud detection solution the power to be so successful? When considering the purchase of a software solution, understanding how and why it works can be an important factor in determining its value.

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16Sep
By Michael Fossey, MS Healthcare Fraud: ICD-10 is NOW
16 September 2015

- After long delays and several false starts, ICD-10 finally goes into effect on October 1, 2015.

 

How will the transition effect medical providers? For medical service providers the immediate impact is substantial. Medicare and major health insurance companies will no longer accept ICD-9 codes to substantiate charges and claims may not contain both ICD-9 and ICD-10 codes. Based on initial reports, there may be leniency in the first year. Some claims will be allowed with minor ICD-10 errors, as long as the code used is in the correct family.

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13Mar
By Stanley Harmsen van der Vliet Uncover how the $1 billion Carbanak heist could be avoided
13 March 2015

- Alleged hackers have struck again, infiltrating numerous banking systems and stealing up to hundreds of millions of dollars in 30 different countries. Security firm and anti-virus maker Kaspersky revealed a new modus operandi that clearly shows how cyber criminals were able to penetrate the core systems affecting more than 100 banks. They successfully targeted banking systems with advanced malware and without having any insider information.

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16Feb
By Stanley Harmsen van der Vliet Catch the modern day criminal in a multi-channel environment
16 February 2015

- From malicious malware to sophisticated phishing schemes, banking institutions and card service providers are under constant, multi-channel attack. How should they respond? One technology company making the news in the fight against financial fraud is INFORM, so we asked Dr. Andreas Meyer, Director Risk & Fraud Division, for his views on the matter, and examine some industry facts about the growing threat of financial crime.

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