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you landed a summer internship with a company that processes dental insurance claims for insurance companies. The company receives the insurance claims from dental offices, achieves authorization from the correct insurance company, and sends payment checks. You do not deal with dental customers directly; instead, you work with insurance companies on one side and dental offices on the other.

After two months with the company, you think a number of frauds may be occurring, and you feel the best way to search for these frauds is to investigate documentary evidence. Because hundreds of dental offices send insurance claims to your office, some may not be real dental offices. You contact the IT department and receive a set of files that represent the documents involved in transactions for the past three months.

You will conduct an investigation toward answering the questions below. You will be considered for testimony as an expert witness. You will prepare a report for the Court of your findings and will also prepare and submit with your report a resume outlining your experience and credentials that make you an expert in your field.

Questions:

1. Some dental offices may not employ real dentists and may be front companies that are sending claims out for work not performed. A real dental office should have a real office address with dental chairs, reception areas, etc. Are any dental offices instead using post office boxes in their payment addresses?
2. Real dentists should be sending claims to many different insurance companies. Since your company only represents a few of these companies, the sequential numbers on the claim sheets from a given dentist will rotate through all of the companies that the dentist is working with. If the numbers sent to you from a given dentist are sequential, you know that the dentist is only sending claims to you. Search the claims file for sequential numbers from any given dental office. Are any sending you sequential claims?
3. A human adult has 32 permanent teeth. Your company requires that each claim list the patient seen (identified by patient ID), the tooth worked on, and the type of work done. Because of the natural limitation on the amount of cavities that could be filled on any one person, it is rare that a person would have more than a few cavities in the three months of your audit (it is possible for a tooth to have more than one cavity). Using this field, calculate the total number of cavities submitted for each patient. Do any patients seem to be visiting the dentist too often?
4. Patients normally need to live close to their dentists because receiving service requires a visit to the office. A good fraud search is to calculate the distance from each customer?s address to his or her dentist?s office address using a geographic information system like GoogleMaps or MapQuest. For this question, simply determine if any patients live in different states than their dentists. Do any patients seem to have a long drive to their dentists? offices?

\fdentist_id 102131 102817 103102 103322 105129 106512 107001 107771 107885 109576 109711 109730 110415 110662 111954 113614 114282 115322 115417 115984 116572 117395 119267 120217 121327 122814 122822 123423 123675 124745 124945 125471 126127 126865 127417 129107 130421 133608 138869 138946 139825 139984 140017 140822 141115 address city 3784 West GrCrestview 282 South LeeCrestview 2014 Miller AChames 2311 West G Belkas 4831 North MChames 4809 South Ma Belkas 199 Laurel St Crestview 1039 East HigBelkas 4492 Sunset SDanniton 1028 West Li Laken 3206 South GDanniton 2677 East MillCrestview 2977 Ash Ave Chames 3183 South FoBelkas 1763 North B Danniton 3449 East MillDanniton 1213 West Le Chames 2948 North NiCrestview 1625 North S Laken 3326 West MaBelkas 3245 South NiCrestview 3203 West S Belkas 3595 South T Crestview 36 Oak Ave. Chames 3868 North LiBelkas 4836 South MCrestview 1855 North C Chames 2728 West PaDanniton 4530 South MDanniton 1102 East HigCrestview 4155 DogwooChames 1041 West WilBelkas 4713 North MiBelkas 3065 North C Crestview 2881 North MiLaken 1460 East MaChames 728 East Rive Laken 4691 West PaCrestview 4552 North F Belkas 756 East Rive Belkas 2599 MadisonBelkas 4713 East WilChames 750 Cedar WaDanniton 1648 North ODanniton 2611 South NiLaken state ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME zipcode 4608 4608 4498 4012 4498 4012 4608 4012 3913 4405 3913 4608 4498 4012 3913 3913 4498 4608 4405 4012 4608 4012 4608 4498 4012 4608 4498 3913 3913 4608 4498 4012 4012 4608 4405 4498 4405 4608 4012 4012 4012 4498 3913 3913 4405 141436 141750 142146 144231 144769 145026 146363 148095 148157 148703 149237 152489 152661 154215 154285 158706 159180 159219 159252 160783 160876 160892 163217 163317 165222 165342 166774 166825 166877 166978 168245 168692 169618 169623 169872 171346 171504 173235 173899 174216 176297 177857 178365 178942 178944 180613 801 South ValChames 3733 Maple 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1720 North S Crestview 4528 Central Laken 54 East GreenBelkas 714 North VallDanniton ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME 3913 3913 4012 4012 4608 3913 3913 4405 4608 4012 4498 4012 4012 4608 4405 3913 4405 3913 4608 4498 4012 4405 4405 4405 4498 4405 4405 4608 3913 4608 4012 4498 4405 4012 4405 4608 4012 4405 4405 4498 4405 3913 4608 4405 4012 3913 604971 605268 605845 608872 610913 611015 611092 612264 614267 615410 615468 615946 616341 618196 618673 618798 619118 621221 621995 623067 625381 625731 625995 626900 627161 628012 628175 628451 630426 630830 630886 632830 633594 634530 634704 638878 641339 641837 643294 643628 644966 645214 645410 645474 646866 647236 2660 West MaLaken 1964 Maple SDanniton 4938 West GrCrestview 2728 North ChChames 3419 Smith StCrestview 1676 Meado Chames 3451 West W Laken 191 East Fore Chames 501 South RidCrestview 1872 North SiChames 1449 East Hi 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3656 North TaBelkas 2912 FourteenCrestview 4487 Maple SBelkas 1772 North MCrestview 4503 North LeDanniton 4403 North MCrestview 355 West Wil Chames 3188 West PoLaken 2325 South S Danniton 691 Jackson AChames 3370 Ninth AvCrestview 4912 West ChLaken 3022 East PopLaken P.O. 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RivChames 2442 Lee Ave.Belkas 3556 North RiChames 524 North La Belkas 3303 Meado Laken ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME 4012 4498 4608 4405 3913 4405 4012 4012 4498 4608 4405 4012 4608 4012 3913 3913 4608 4608 4498 4012 4498 4498 3913 3913 4012 4498 4012 3913 4012 4012 4012 4012 4012 4608 4608 4608 4012 4012 4012 3913 4012 4498 4012 4498 4012 4405 796794 798299 800011 800551 801095 801154 803812 804409 804655 805558 805775 806968 807309 807318 807627 807650 810479 811704 812117 813109 813452 814282 814332 815295 815974 817192 817369 817630 817644 817793 818646 819294 819572 820051 820295 821265 822614 823694 824676 826070 826399 828128 829633 830348 831602 831935 4793 North S Crestview 4793 Lee WayDanniton 1247 North R Crestview 2033 East Pi Crestview 3479 East WilDanniton 3503 North ChDanniton 2534 East MilChames 776 East ForesBelkas 1914 East Le Laken 2709 West HigCrestview 322 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