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: The article is based on a study of causes of insolvency and decisions made by management, regulators, and policyholders over the life cycle of the insolvency.

Description: Many top-performing businesses aren’t just risk aware, but rather risk intelligent. Such a posture helps prepare companies for a major event and can demonstrate to a regulator or auditor that an appropriately strong control framework is in place. Better still, companies gain real strategic value from a “risk adjusted” understanding not only of their threats and vulnerabilities, but also the upside opportunities associated with various risks. It starts with having both qualitative and quantitative information to identify, assess and manage risks. Strategic risk management, at its core, is about creating value by increasing transparency and accountability, and quality of information. More than a mere compliance exercise, effective risk management enables more informed strategic decision making, increased accountability and transparency, a greater likelihood of organizational success, and – ultimately – competitive advantage, as borne out by many studies that correlate risk management and financial results.

Description: Part 1 of a 2-part series exploring implementation issues for the Mental Health Parity and Addiction Equity Act of 2008 MHPAEA. Part 2 addresses the new enforcement safe harbor, how the regulations could impact the business of behavioral health care and the impending decisions for payors, employers, providers, and insureds.

Description: Career planning

Description: Article Description * “Agile” development is all the buzz in the IT world. You may have heard your IT teams talk about scrums, sprints, and the war room and wondered if they were playing a strange new sport. Or perhaps you are already applying agile techniques in your product development. This article will discuss what agile methodology is, pros and cons, and how you might apply it to insurance product development.

Description: Financial institutions have and continue to suffer substantial financial losses because of their exposures to various operational risks and insufficient risk management. Quantifying operational risk is a critical component of an institution’s ability to manage risk. The model described in the article provides a numerical measure for operational risks existing in a business entity through statistical methods. It takes experience data to reflect both the general features and company specifics of the defined operational risks, while also allowing for managerial discretion. An important achievement is to suggest a level of capital to hold against potential losses arising from operational risks.

Description: Hear from the editor’s on the December 2018 issue of Risk Management published by the JRMS.

Description: A look at cognitive biases, which are common tendencies of people when thinking about issues and when making decisions. Confirmation bias and sunk cost effects.