Ohio Digital

Government Summit
ERNIE STEVENS
Senior Manager
Accenture, Federal Services Consulting
ernie.stevens@accenturefederal.com

Why fraud matters

In 2012, the Federal

government spent over
$400 billion dollars on:
Medicaid, SNAP, EITC
and SSI

For example, if these programs had

a fraud rate of 1%, which is the
average trafficking rate for SNAP
benefits, total fraudulent payments
would be over $4 billion.

News stories create a negative public perception, such as:

Kentucky woman concealed her living
arrangements to collect ~ $280,000 in
fraudulent Supplemental Security Income
(SSI) and Medicaid benefits.

Copyright 2015 Accenture All rights reserved.

11 Louisiana residents concealed their

living arrangements and earnings to
collect over $81,000 in Supplemental
Nutrition Assistance Program (SNAP) and
Child Care Assistance Program benefits.

Proven success factors to

help detect and prevent fraud
1

Build a program with the end in mind

Apply analytics as an ongoing response

Partner for success

Focus on citizen spend behaviors

Pilot your model before full operationalization

Copyright 2015 Accenture All rights reserved.

Build a program with the end in mind

1
Identity Resolution
Performance
Measurement

Forms & Benefits

Processing

Technical &
Data Architecture

Fraud Detection

Fraud
Diagnostic
Workforce Planning
& Training

Intelligence-Led
Investigation

Governance &
Change Management
Client Education
MARKET-LEADING
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COMPETITIVE

Intelligence-Led
Dispositions
BASIC
4

Apply analytics as an ongoing response

2
Develop a range of
analytical models

ANALYTICS
LABORATORY
(INSIGHT)

Create customer
analytic record from
internal and
external data

Measure and track

the value delivered;
Evaluate the results and
amend the models
Copyright 2015 Accenture All rights reserved.

BUSINESS
OPERATIONS
(INTEGRATION)

Integrate the
models into Business
Processes & Systems

Optimize
Business
Processes

Partner for success

3
Integrated Datamart

Individual attributes and behaviors

Relationships between individuals or groups

Migrate state
and federal data

Prepare data in
Integrated Datamart

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Analyze data to identify

trends in behaviors and
characteristics

Focus on citizen spend behaviors

4
OUTLIER ANALYTICS

SOCIAL
NETWORK
ANALYSIS

EXPERT RULES

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PREDICTIVE
ANALYTICS

DATA MATCHING

Focus on citizen spend behaviors

OUTLIER ANALYTICS
Identifying unusual cases, which
may indicate non-compliance
Essential for catching new types
of fraud and non-compliance

Copyright 2014 Accenture All rights reserved.

Focus on citizen spend behaviors

PREDICTIVE ANALYTICS
Using previous confirmed frauds to
predict the likelihood of future cases
Most suitable for high volume
investigations, generally provides
the highest yield improvement
across all techniques

Copyright 2014 Accenture All rights reserved.

Focus on citizen spend behaviors

DATA MATCHING
Bring together data from multiple
sources for interrogation
Utilize unstructured data
Enhances ability to cross check
values and spot anomalies

Copyright 2014 Accenture All rights reserved.

10

Focus on citizen spend behaviors

EXPERT RULES
Utilizing the extensive expert
knowledge of investigators
Helps with front line buy in and
complements other techniques
Essential to validate rules on
an ongoing basis

Copyright 2014 Accenture All rights reserved.

11

Focus on citizen spend behaviors

SOCIAL NETWORK
ANALYSIS
Understanding the complex
relations across networks

Powerful investigation support

tool, to understand links between
risky components
Useful for Scheme and Collusion

Copyright 2014 Accenture All rights reserved.

12

Pilot your model before operationalization

5
Even after the model has been operationalized, it still requires
maintenance to retain its effectiveness and improve its usefulness.

2
Identify Analytics
Base Data

Identify Known
Fraud Cases

5
Successful
Field Test

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Analytics
Magic Occurs

Operationalize

Maintain &
Optimize

13

Fraud analytics success story:

Supplemental Nutrition Assistance Program (SNAP)
San Bernardino County
Largest county in the contiguous US
(20K sq mi)

Population ~2.1M
333K CalFresh (SNAP) participants

Objective
Develop an analytical model to
improve the efficiency of the
fraud investigation process

$50M issued per month in CalFresh

Goals
Reduce false positives:
- Prevent unnecessary disruptions to
compliant participants

- Improve operational efficiency

- Baseline for legacy processes were
findings in 6.1% (comparatively good)

Client and Accenture agreed

that a 10% increase in the hit
rate would be a good measure
of success (from 6.1% to
6.8%).

Gain insights into key markers for fraud

Copyright 2015 Accenture All rights reserved.

14

Implement these key factors to

successfully detect and prevent fraud
1

2
3

4
5

Build a program with the end in mind

Governments have many options for analytics capabilities; start with the vision for
business impactand determine the necessary capabilities with the end in mind

Apply analytics as an ongoing response

Dont treat analytics as a one and done event, rather, analytics should be integrated
into business operations as part of the ongoing management process

Partner for success

Integrate data from a variety of federal, state and local sources to get the richest data
and highest quality of analyses and insights

Focus on citizen spend behaviors

It is critical to look beyond transaction-level data to citizen behaviors to
identify sources of fraud in eligibility and misuse

Pilot your model before full operationalization

It is best to pilot the model before investing in automation technology

Copyright 2015 Accenture All rights reserved.

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