Description: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.

Description: Delinquency rates are closely related to the economic conditions and can be analyzed using measures of economic growth and stability. In an attempt to predict the delinquency rate for the health care equipment financial industry, we investigated the relationship between delinquency rate and key macroeconomic variables for the period from 1998 to 2008. The study reveals that the tightening credit standards and unemployment rate are the key macroeconomic indicators influencing the delinquency rate. The analysis further helps in arriving at a trigger to monitor the delinquency rate based on the macroeconomic indicators, thus enabling proactive portfolio management. Presented at 2010 Enterprise Risk Management Symposium, Society of Actuaries, April 12-15, 2010.

Description: This dissertation by Tia Sawhney will help you understand this issue and start measuring it, or start promoting equitable public policy.

Description: Report on the activities of the Academy’s health practice council and its work groups.

Description: In this article, the author discusses the considerations and advantages of implementing an integrated enterprise risk management program for a health insurance company, and presents a summary of Aetna's experience with ERM as a case study.

Description: This article from major US payers describes palliative care as a scaleable means of improving quality and reducing costs during serious and complex illness.

Description: Discussion of the economics of a possible H5N1 pandemic, and its impact on Life, Health, and Property and Casualty insurers, in terms of areas of risk, especially underwritng risk, operations risk, and market risk.