WellPoint's John Steffy: How to use social media to detect healthcare fraud
FHP:AF: Do criminals use social media to carry out or boost profits of healthcare fraud schemes? If so, how?
Steffy: Criminals do use social media. Some groups, for example, try to steal data and information on beneficiaries. Often, criminals are able to hack partial data lists. Once they have these, criminal groups can avail themselves of different media to socially engineer additional data on victims. If criminals have the name, height and weight of an individual and perhaps their address, they can use social media to get a birth date and fill in other personal details.
FHP:AF: In your opinion, is it a good investment for insurers to buy prepackaged social media data from external sources? Why or why not?
Steffy: That's an interesting and difficult question because every insurer SIU has a particular set of tools at their disposal, and one payer's SIU may not have the same tools as another's. Each SIU has to look at the tools they have and compare them with available social media tools and resources to see if there's a good fit for the company's particular needs.
And the answer to this question today may not be the same as the answer tomorrow, because technology in this field is constantly changing. Every day, there's a new social media site, and every day it seems there's a new program out there to troll for information in social media.
FHP:AF: Do you have any other tips for fraud investigators?
Steffy: Many investigators think of social media as social networking sites such as Facebook and Myspace. But those are just one subset of what's available. You also want to keep in mind Yelp, LinkedIn and other sites geared toward the exchange of more professional, user-generated content. Those sites can be helpful in identifying potential witnesses, leads and targets. It's very easy, for example, to look at the Yelp site and do a search for "medical mill" or "pill mill." You'll end up with a list of results that you can typically narrow down by geographic area.
In addition to that, always keep in mind that social media are basically a self-disclosed network analysis. So anytime you have an investigation target, it's easy to use social media tools to augment or build on what you already know their network analysis is.
Editor's Note: This interview has been edited for length and clarity.
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