Jack Maple - The Crime Fighter

Jack Maple - The Crime Fighter

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What you can learn from: Crime Fighter
by Jack Maple with Chris Mitchell

In Crime Fighter we learn that enforcing sound principles can turn a losing fight against crime into a winning fight. Using the four principles below, the NYPD dramatically reduced crime in just two years (from 1994 to 1996):

1) Accurate, timely intelligence. Everyday each precinct reviewed their crime statistics on a map that was posted in the station. At each level, decision makers were help responsible for the crime in their area. They would use the maps to help establish patterns and track down the criminals.

We’ve got to make it easier for people to submit accurate bills quickly, then we’ve got to monitor billing daily or weekly, rather than monthly or quarterly. And we need good intelligence about what we’re fighting. Right now, we only know about a fraction of the fraud that is being committed.

2) Rapid deployment. They put cops where the maps showed there was a lot of crime (he calls it “put cops on dots”, at the times when there was a lot of crime. Previously, most detectives had worked 9 to 5 on weekdays. It is no surprise that that was not when most of the crimes occurred. A lot of crimes occurred as officers were changing shifts, and many officers decided they would rather go home on time than stop a crime.

What is the lesson for fraud? First we need to have more “cops on dots.” We don’t have the manpower to come up with all the ideas, much less to follow through on them. Where possible, we need to use automation to bring our attention to where the dots are. We need to have some security that flags claims in real time for review. We’ve got to stay on top of new patterns and build cases quickly. We’ve come a long way in this area, but we’re still lagging too far behind the crimes.

3) Effective tactics. Maple outlines seven tactics they used to accomplish the goals of: arresting people early in their crime spree, pressuring them to abandon their worst behavior and take away their guns. For us, this translates into: catch them early, put restrictions on their participation, and take away their licenses (and don’t let them get licensed elsewhere).

4) Relentless follow-up and assessment. Maple helped setup cold case units that would go over old cases to see if anything had been missed. They’d work with the original detectives to make sure that they learned from their mistakes.

It seems like in fighting healthcare fraud, we rely almost entirely on cold case evaluation. We’re reviewing claims months or years after the service occurred. If we had real time investigations of crimes early in the spree, then the cold case investigations would focus on what was left and help us improve the quality of our real time investigations.