WellPoint's John Steffy: How to use social media to detect healthcare fraud
Social media sites can provide a wealth of information to aid in healthcare fraud investigations. But how do you wade through all that information--and interpret the results?
In fact, there's no substitute for manually reviewing sites, says John R. Steffy, a senior investigator in WellPoint's northeast special investigations unit.
But you might be surprised at the different kinds of fraud you can uncover through sites such as Facebook, Twitter, Pinterest and even MySpace. (Yes, MySpace still exisits.)
There's much more to it than finding photos of a person who is collecting disability payments crossing a marathon finish line.
To learn how insurers can make the most of data mined from social media sites, FierceHealthPayer: AntiFraud spoke to Steffy, who specializes in investigating healthcare fraud by organized criminal groups, He previously worked for the Kings County district attorney's office in Brooklyn, New York.
FierceHealthPayer: AntiFraud: What types of intelligence can fraud investigators gather through social media sites? Why is this intelligence valuable?
John Steffy: Social media sites are excellent places to gather open-source intelligence. A typical example is finding a photo of a person who's water skiing and may have submitted a claim for broken leg. Commercial payers and government investigators like this kind of intelligence because it acts as a checkmate on the fraudster.
But there's other valuable intelligence out there as well. Investigators will want to look at Facebook, Twitter, Foursquare, Pinterest and Myspace. People love to talk about where they are and what they're doing, and even our photos are geo-tagged these days. This becomes useful when a provider bills for services on dates when he or she may have been in Rome, for instance, or elsewhere on vacation. It's very powerful to confront a provider you may suspect of fraud with photos that indicate they were out of the country on the date they billed a particular payer for services.
FHP:AF: How is social media intelligence most efficiently gathered?
Steffy: There's no substitute for manually reviewing social media available on the internet. This allows investigators to familiarize themselves with different sites and different types of user-generated content contributed to each site.
Each site has its own interface. It's important for an investigator to know the difference, for example, between LinkedIn--which is usually aimed at a professional audience and includes information that doesn't change often--and Twitter, where updates are brief and constantly changing. Twitter information might be small and truncated, but it's very up-to-date.
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