Fraud, waste, and abuse (FWA) are a pervasive challenge in our society across both public and private sectors.
As one state agency in New England put it, “Public Health challenges like COVID-19 brings out the best in society unfortunately, bad actors seek to exploit others during emergencies.The COVID-19 pandemic has only emboldened scammers seeking to defraud healthcare-focused government agencies; unemployment agencies; social service organizations; research, economic aid, and grant programs.”
Offices of the Inspector General (OIGs) at Federal and State and Local agencies are on the frontlines of dealing with dramatic increases in the number of fraudulent claims for unemployment and other Covid related assistance. Government agencies have tried to fight fraudulent claims and stop bad actors for years but news reports calling this “The Fraud of a Generation” cite the scale of the problem.
- $80 billion — or about 10 percent — of the $800 billion handed out in a Covid relief plan known as the Paycheck Protection Program was improperly paid out
- According to news reports up to $400 billion is believed to have been stolen from Covid unemployment relief programs
A recent press release from the US Department of Justice stated that “COVID-19 health care fraud enforcement actions involve extraordinary efforts to prosecute some of the largest and most wide-ranging pandemic frauds detected to date, that require an unprecedented interagency effort to quickly investigate and prosecute those who abuse our critical health care programs.”
Making Senses of Volumes and Volumes of Data
The sheer volume of claims for healthcare, unemployment, program support, and the related data to be reviewed makes detecting FWA extremely challenging, resource intensive, and costly.
How can harmful schemes and fraudulent claims be stopped before they negatively impact the financial stability, service quality, and outcomes of public healthcare, social services, and support programs?
In the past, public healthcare, unemployment, and social support organizations would turn to customized solutions provided by big IT vendors. These approaches are slow to deploy, costly, and lacked the agility to respond to the changing dynamics of FWA without more investment in time and resources.
Solving these FWA-related “Big Data” challenges does not require a big money investment in a custom crafted analytics system. Instead, what is required is the agility to quickly leverage vast volumes of data, streamlining the process to clean, prep, and prepare data for analysis. Beyond just data prep, however, Alteryx enables all levels of analysis from descriptive, predictive, and advanced analytics including geospatial and the ability to analyze unstructured text data all key features needed to investigate cases of fraud, waste, and abuse.
In one Midwestern state, in response to the requirements of a $550 million grant from the Federal Child Care Relief Program, the state’s DHS team is leveraging Alteryx Analytics Automation to combine data from multiple business processes, including enrollment, eligibility, payment processing, and more. The combined data is reviewed and analyzed to find anomalies, duplicates and other flagged activity. With analytics automation, the small staff of OIG investigators is able to investigate fraud with a degree of insight unavailable in manual processes. Additionally, the state’s DHS staff is much better able to meet Federal regulatory reporting requirements.
How It Works
Alteryx is a unified, self-service platform that can automate the entire analytics lifecycle, from prep and blend to modelling. It leverages powerful, low-code/no-code analytics, including predictive modeling, geospatial, and machine learning to help agencies and organizations increase their ability to detect FWA quickly, including instances that had previously been undetectable.
With Alteryx, organizations responsible for investigating cases of FWA can streamline and automate labor-intensive analytics processes, eliminating thousands of hours of tedious tasks, such as conducting manual audits and analysis. With Alteryx, organizations can tremendously accelerate their ability to fight FWA, conduct audits, and identify non-compliance by proactively identifying anomalies, uncovering hidden connections in data, and modeling trends with predictive analytics all within a no code/low code unified analytics platform.
Additional Proof Points:
- Alteryx was fundamental in rebuilding a U.S. state’s unemployment system. Alteryx was able to handle data from 2M+ applications, connecting information across enrollment, eligibility, adjudication, and fraud investigation business processes.
- A U.S. state’s audit department was able to compile and analyze complicated 1099 data sets to enhance insight and increase efficiency in audit execution.
- Alteryx is the analytics platform for a state government across 133 different agencies and was instrumental in finding over $1 million in duplicate payments.
- Alteryx enables a Federal OIG team to quickly scan a 20K page monthly phone bill, identifying anomalies and possible sources of fraud and waste.
Next Steps
Taking no action against FWA is not an option. Advanced analytics capabilities, made possible with Alteryx, empower easy-to-use, effective solutions that agencies need to interpret and leverage large volumes of disparate data and formats, automate key processes to become more efficient, and produce better, accelerated outcomes that maintain fiscal integrity and optimize service delivery to those in need.
Read more about how Alteryx is empowering government agencies with insight to fight fraud, waste, and abuse by downloading our latest paper.