The Diary of Jen Q. Public: Pinky swears and analytics
May 1, 6:38 a.m.
Last night I had a really strange dream. The Social Services office asked me to pinky swear that a claim I was filing was accurate. “Well, yeah.” Did they think I looked like someone who would file a false claim? It took a whole lot of deep breaths to just smile and nod and raise my crooked pinky.
Do government agencies really rely on the pinky swear to validate accuracy of claims and minimize abuse? Of course not, that was just a really weird dream. But program integrity is a real problem, and government social programs lose a great deal of money to errors, waste and abuse. These agencies typically are underfunded, and this money could be used to provide services and benefits to those who sorely need them.
For example, just a couple weeks ago a West Hartford, Connecticut man was sentenced “to serve 21 months in prison for defrauding a trio of government assistance programs by fraudulently collecting Unemployment Compensation and Food Stamp benefits and billing Medicaid for work he did not do.” And at a recent US Congress hearing of the Ways and Means Subcommittee on Oversight, Chairman Peter Roskam said, “last year, the federal government lost USD124.7 billion dollars in improper payments across 124 programs." Waste, abuse and even accidental errors do pose a real problem.
Social program administrators are doing their best to ensure that proper benefits—payments and services—get to the right people at the right time. But with citizens demanding more digital services, program compliance directors struggle to keep up with ever-evolving fraud schemes. And, of course, errors are an unfortunate reality in any organization. A pinky swear resolution for the problem would be wonderful, but in reality it requires a bit more effort. That’s where analytics comes in. Today’s advanced analytics solutions can help in the following ways:
- Proactively identify and prevent fraudulent activity before improper payments are made
- Maintain a robust network of compliant healthcare providers
- Simplify and automate administrative procedures to increase productivity
- Quickly distinguish fraudsters from law-abiding citizens
- Improve the effectiveness and efficiency of caseworkers and investigators
- Detect suspicious behaviors either retrospectively or at the time a request is filed
Government agencies owe it to themselves to see how analytics can help. I think they’ll find them very useful. And that’s a pinky swear.
Until next time!
Jen Q. Public