Case Study 2

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.

Download the following files from the textbook's Web site:

• ch08_dentists.csv - https://docs.google.com/spreadsheets/d/1WeKErV94tB_C-LQNKrBPb5VahMvYMGmbyoNxNobsx30/edit?usp=sharing

• ch08_claims.csv - https://docs.google.com/spreadsheets/d/1kNoelXMko45F2_V7UEkm6P1r538a5ww29accN740Txs/edit?usp=sharing

• ch08_patients.csv - https://docs.google.com/spreadsheets/d/1lRE3y_Bh5Ew4Vh1UzouiJDJoB7DJRbtT0-TIKtDSgN8/edit?usp=sharing

Questions

1. 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 Google Maps 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?

NOTE: The link provided in the Excel documents that need to answer the questions. That link needs to copy and paste in the browser to go to the document. We can't attach the document here.