Abstract: Methods and systems of the present disclosure include identifying and addressing potential healthcare-based fraud, according to one embodiment. The methods and systems identify potential healthcare-based fraud associated with potentially suspicious healthcare providers, patients, and/or claim submissions, in one embodiment. According to one embodiment, the methods and systems acquire data associated with a healthcare provider, patient, and/or claim submission; apply the data to one or more predictive models to generate one or more risk scores to identify potential healthcare-based fraud, and perform one or more risk reduction actions based on the one or more risk scores, according to one embodiment.

Abstract: Methods and systems of the present disclosure include identifying and addressing potential fictitious business entity-based fraud, according to one embodiment. The methods and systems identify fictitious business entities associated with fraudulent tax return filings, in one embodiment. According to one embodiment, the methods and systems acquire data associated with an employer identification number (EIN), apply the data to one or more predictive models to generate one or more risk scores to identify potentially suspicious EIN data, and perform one or more risk reduction actions based on the one or more risk scores, according to one embodiment.

Abstract: Account takeover and stolen identity refund fraud are types of Internet-centric crime (i.e., cybercrime) that include the unauthorized access or use of a user account or identity information to file a tax return in order to obtain a tax refund and/or tax credit from, for example, a state or federal revenue service. Because fraudsters access legitimate user accounts or use legitimate identity information to create user accounts, it can be difficult to detect fraudulent activity in user accounts. Methods and systems of the present disclosure facilitate the identification and prevention of potential fraudulent activity in a financial system, according to one embodiment. The methods and systems automate fraud claim receipt, predictive model training, risk score threshold improvement/optimization, and/or investigation of potentially affected user accounts, according to one embodiment.

Abstract: Account takeover is one of a number of types of Internet-centric crime (i.e., cybercrime) that includes the unauthorized access/use of a user's account with the user's identity or credentials (e.g., username and/or password). Because fraudsters acquire user credentials through phishing, spyware, or malware scams, it can be difficult to detect unauthorized access of a user's account. Methods and systems of the present disclosure identify and address potential account takeover activity, according to one embodiment. The methods and systems acquire system access data, apply the system access data to one or more predictive models to generate one or more risk scores, and perform one or more risk reduction actions based on the one or more risk scores, according to one embodiment. The financial system is a tax return preparation system according to one embodiment.