Sergey Semichev is a new addition to the eSimplicity team. Here, he advises CPI leadership on strategic cloud initiatives that will allow for optimum artificial intelligence/machine learning solutions that will enhance CMS Fraud, Waste, and Abuse programs. On his journey fighting fraud and reading Sci-Fi, here’s our chat with one of eSimplicity’s newest employees.
Tom Hindle: Thanks for joining us, Sergey. Got a few things to get to here, but first, what’s your career overview?
Sergey Semichev: Before I decided to move to the United States, I lived in Kiev, Ukraine. I worked for a software outsourcing business. My role was to meet with potential customers and understand their business needs. I would lay out the groundwork for the initial engagement and then would move to other projects to try to find new contracts and customers for the company.
My first job in the U.S. was for a startup company in California. I worked there for several months and then moved on to Bloomberg in Crystal City, VA.
TH: And what was that change like?
SS: It was absolutely a different experience and environment. Each city has its own culture and traditions from the way people dress to the way they celebrate holidays.
In 2013, there had been many new advancements to technology. People were talking about “AI” and “Machine Learning”, but now we know how to actually use them. For example, your cell phone likely has multiple applications that understand how AI works.
After Bloomberg, I worked for another company whose goal was to build a digital platform and provide services for the 2016 U.S. presidential election.
TH: But at that time, AI and Machine Learning were new?
SS: Yes, it had just started. The technologies were a 0.1 version. After the 2016 election was finished, I joined another startup. My goal was to build a machine learning platform in the cloud that helps data scientists with the entire machine learning lifecycle. I enjoyed the environment and multicultural team. Our team was distributed; people were located in Argentina, Brazil, Ukraine, or Russia. It was a great experience for everyone.
One of our customers was Lockheed Martin. This was the first time I saw image recognition in action — how AI could help to solve a real problem. We would receive pictures from satellites that were difficult for humans to recognize and understand, but our systems worked to recognize what was there.
Next, I joined Capital One. I worked there for three years. I was involved in multiple parts of Capital One’s business. For my first project, I was responsible for building services to help predict failures for the whole ATM fleet. In my next project, I joined the cloud AI department. My responsibility was to build multiple services to prevent different types of fraud. It’s interesting nowadays because fraud is not only credit card transactions.
TH: It’s data as well right?
SS: Yes, but the question is, how can you use it? How do bad guys use it? If somebody somehow steals a credit card, it’s definitely fraudulent, but there are a lot of other cases to consider. Stealing your personal information and data is just one step. The second is what can you do with it? There are multiple cases, and I worked in that area. After that, I decided to join eSimplicity!
TH: So what have your responsibilities been here so far?
SS: eSimplicity is the prime contractor for a contract supporting our client CPI — a part of CMS. It’s a multiyear contract and our team is five people. We serve as advisors to the agency and collaborate with other contractors and programs at CPI to help them build a roadmap and define strategies for machine learning, Cloud adoption, and AI adaption. So I research the current state of CPI systems in the cloud, identify strategic objectives, constraints and pain points. Finally, I draft cloud recommendations that address objectives and create a foundation for AI and machine learning.
TH: And how does that help someone’s day to day life?
SS: The biggest problem at CMS and CPI is fraud. It’s a different type of fraud though — not from customers, but from medical providers. For example, a provider may recommend the wrong type of treatments to make them more expensive, or make a false claim. Basically, helping CMS to better fight fraud, waste, and abuse improves the quality of services provided to beneficiaries and saves taxpayers money.
TH: So they get more money, basically?
SS: Yes. So it’s not a fraud from beneficiaries, it’s a fraud from medical providers. Money is certainly one motivator for fraudulent providers — the government pays them based on the types and quantity of services that they provide. What’s also important is the quality of medical care provided to beneficiaries. If a provider is not supplying the care that they claim to be, the beneficiary’s quality of life suffers. The amount of money potentially lost is huge, around $60 billion annually is what they estimate.
TH: People at eSimplicity say they’re doing something that helps people in their day-to-day lives. Do you feel as if you’re helping people through a business lens?
SS: Yes, definitely! If you can save the government a huge amount of money, it’s a huge benefit. It’s our taxes, your taxes, my taxes. If you can minimize the fraud, it will help the whole system work better and everyone benefits.
TH: What do you enjoy doing outside of work? Any hobbies/interests you want to share?
SS: I really like swimming, but unfortunately it’s not a good time to be swimming. I still like running and biking. I live very close to Great Falls National Park in VA, where there are lots of good trails to walk, bike and run. I try to be active every day. I also enjoy my two cultures. I can read English and Russian. I really like to read Sci-Fi as well. Sci-Fi is very popular in modern Russia.
TH: Where do you hope eSimplicity goes from here?
SS: With CPI, eSimplicity is proving itself as a trusted advisor. Looking forward, we plan to help CPI execute on our advice by actively managing their cloud infrastructure and supporting AI implementation. Beyond CPI, eSimplicity is aiming to assist CMS CCSQ with managing its Central Data Repository (CDR) and analytics platform (CAP).