Government
Solution Brief
Business Impact
Challenges
US government agencies made
improper payments totaling $106
billion in fiscal year 2013, according
to the Office of Management and
Budget.
•Insufficient or conflicting information.
Without a trustworthy, single version of the
truth, auditors can’t easily protect government funds from improper payments.
• Limited analytic capabilities. Outdated
methods leave agencies susceptible to
organized crime and illegal or unethical
billing practices.
• Changing nature of fraud. Perpetrators
frequently change tactics, and legacy
detection techniques can’t keep pace.
• Manual processes. Manually gathering
and preparing data for fraud detection
is tedious, time-consuming and highly
error-prone.
Take a Proactive Approach to Fighting Improper Payments,
Fraud, Waste and Abuse
The Issue
Our Approach
The government, like the private sector, is vulnerable to fraudsters –
both outsiders and insiders – who attempt to cheat and abuse the
system, especially in times of economic turmoil. Each year, billions of
tax dollars paid by hardworking citizens are lost to improper payments
due to fraud, error, waste and abuse. Systemic fraud and frequent
errors in government agencies have caught the attention of elected
officials, industry associations, government watchdogs, the media and
taxpayers, who blame poor planning, lack of accountability and
minimal transparency for at least part of the problem.
Fighting improper payments requires fixing poorly designed
processes and detecting fraudulent activity in enormous amounts
of operational data. SAS delivers software and services to help you:
In the UK, the latest National Fraud Authority estimate shows that
55 percent of fraud – a massive GBP 21 billion (US$33.6 billion) –
is committed against the public sector. In the US, the federal government’s improper payments totaled $106 billion in fiscal year 2013
as unemployment insurance and Medicaid payments increased.
To combat such problems, governments need to use an intelligent
approach to data analytics that will detect abnormal patterns, link
multiple parties, automatically route suspicious cases for further
investigation, and use predictive modeling to uncover new potentially
fraudulent activity. Government departments should also accelerate
collaboration efforts and adopt data-sharing policies.
• Improve information credibility by integrating disparate data
sources and using embedded data quality to ensure accuracy.
• Enhance audit and investigation effectiveness by visualizing data
from multiple angles to predict future risks, uncover hidden relationships and detect subtle, suspicious patterns of behavior.
• Deliver insight for quick, confident decisions using an interactive,
web-based portal to generate meaningful reports.
• Demonstrate financial accountability with a consistent approach
that monitors expenditures and tightens internal controls.
• Measure program performance by defining and monitoring key
metrics via a dashboard environment.
SAS provides an end-to-end approach using a technology framework
that integrates with existing IT infrastructures, facilitates the flow of
information across departments and functions, and supports future
technologies and business processes.
The SAS® Difference:
A continual process of analysis and refinement
Case Study:
A US Federal Agency
SAS has a proven foundation for financial intelligence and
performance management, along with best practices that tie together
all essential areas of fraud management. With our industry-leading
fraud framework, you can develop a cohesive strategy for control,
discovery, prioritization and deterrence to address your agency’s
unique objectives and business processes. SAS has comprehensive:
Situation
• Detection and alert generation that uncovers suspicious activity
using multiple analytic techniques, then automatically routes
suspicious cases for further review.
• Alert management capabilities that let you assemble alerts from
multiple monitoring systems, associate them with common
individuals or entities, and automatically prioritize and route
potentially fraudulent cases to appropriate team members.
• Social network analysis for reaching beyond individual views
to analyze all related activities and relationships at a network
dimension – so you can uncover previously hidden linkages that
would otherwise go undetected.
• Case management capabilities that facilitate systematic
investigations and allow you to capture and display all information
that’s pertinent to a case.
No other solution provides better detection of – and greater insight
into – improper payments, fraud, waste and abuse. And because
SAS has more than 35 years’ experience working with government
agencies, you know that you have a trusted partner who will be there
to guide and support you as your needs grow and change.
A provider for state-of-the-art human resources management leadership, services and tools, the agency oversees a variety of employee
benefit programs such as retirement, life insurance, long-term care
and health insurance. It also conducts nationwide audits on more than
400 health insurance companies that serve more than 9 million federal
employees and their families. Determining which claims represent
instances of fraud, waste or abuse is a primary challenge.
Solution
The agency uses SAS to combine, analyze and share claims
information, which:
• Enables auditors and agents to search for fraud and payment
errors.
• Identifies duplicate payments, claims not coordinated with other
insurance, overpaid assistant surgeons and a variety of other types
of claim payment errors.
Results
• Recovered millions of dollars in overpaid claims in five years.
• Experienced a 50 percent reduction in time spent reviewing
benefit claims.
• Freed auditors’ time so they could perform more comprehensive
analyses and more reviews.
What if you could …
Improve information
credibility
Enhance audit
effectiveness
What if you could easily
eliminate duplicate names,
addresses and other identifying information from your
data to reduce erroneous
payments and duplicate
billing?
What if you could predict the
likelihood of a transaction
being fraudulent, and flag
suspicious activity for further
investigation?
Deliver fact-based insight
What if you could not only
access reports that measure
your progress toward reducing
fraudulent payments, but
also drill down for details at
the department level?
Achieve financial
accountability
What if your financial system
could track purchases,
payments and costs to
ensure they’re justified?
You can. SAS gives you
THE POWER TO KNOW®.
SAS Facts
• SAS helps customers at more than
70,000 sites improve performance
and deliver value by making better
decisions faster.
• All 15 major US federal departments
rely on the power of SAS software.
Learn more about SAS software and services for government at: sas.com/gov
SAS and all other SAS Institute Inc. product or service names are registered trademarks or trademarks of SAS
Institute Inc. in the USA and other countries. ® indicates USA registration. Other brand and product names are
trademarks of their respective companies. Copyright © 2014, SAS Institute Inc. All rights reserved.
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• Approximately 85 percent of independent US government agencies and
commissions use SAS.