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Jen Q. Public: Governments can win the improper payment chase with analytics

Digital Marketing Lead, Public Services Sector, IBM Analytics


September 3, 2:30 PM

Dear diary,

The i2 Summit Twitter stream was a fire hose of great insights and useful nuggets on how together we—citizens, government agencies and the private sector—can create a safer planet. A couple of tweets on financial crime, however, caught my attention—specifically, a tweet from @randy_haines:

Wow! $3.5 trillion…not million or billion but trillion. Just last Wednesday, Fox 8 reported that a North Carolina doctor was charged with submitting claims to Medicaid and Medicare for services he didn’t provide. Even more disturbing is the ABC News report of a $60 billion loss to Medicare fraud as a result of monies sent to unchecked addresses. Fraudsters don't even have to play the lottery when $60 billion is seemingly so easy to get! 

How do these improper payments keep happening? How do we minimize the waste and abuse plaguing our government agencies?

With fraudulent schemes on the rise, social services agencies have the daunting task of balancing equitable services to citizens with minimal waste and error. Unfortunately, today’s agile and innovative technology brings with it equally agile criminals. This mandates that government agencies intensify their approach to counter-fraud management and employ analytics. Chatting with Michael Stevens, IBM’s government industry solutions expert, he mentioned that “the IBM Counter Fraud Management and Improper Payments for Government solution is designed to help agencies avoid the ‘pay and chase’ scenario by intercepting transactions in real time that are potentially fraudulent, while detecting, identifying and building the case against past fraudulent activity and improper payments.”

Pay and chase ends up in a continuous pursuit with the government and citizens being on the losing end. The reports of monies loss tell that tale. Stevens went on to say that “if governments utilize advanced analytics, they can reduce overpayments by improving eligibility information matching, gaining insight into familial relationships, enhancing intake and eligibility determination and reducing fraudulent claims through identity resolution.”

Let’s use analytics to put an end to chasing improper payments.

Until next time,

Jen Q. Public