Uncovering social service fraud saves millions, reinforces
public trust
Los Angeles County uses SAS® to detect fraud, resulting in fewer
losses, lower investigative costs and greater confidence from
citizens
In Los Angeles County, the Department of Public Social Services
(DPSS) offers a range of programs to alleviate hardship and promote
health, personal responsibility and economic independence. Across
the county's many communities, DPSS offers temporary financial
assistance, employment services, free/low-cost health insurance,
food benefits, in-home supportive services for the elderly and
disabled, and other financial assistance.
To assist in program integrity efforts in the CalWORKs Stage 1
Child Care Program, LA County turned to SAS® Analytics solutions to
identify potential fraud, enhance investigations and prevent
improper payments. A data mining pilot project revealed an 85
percent accuracy rate in detecting collusive fraud rings, with
estimates of cost avoidance totaling $6.8 million. Convinced by the
results, the county decided to move forward with implementing the
Data Mining Solution (DMS) Application for the CalWORKs Stage 1
Child Care Program on May 2011. By proactively battling fraud, DPSS
is helping the most vulnerable members of the community while
protecting millions in taxpayer dollars.
The system analyzes social networks to determine if individuals are
likely to commit fraud. It also helps identify collusive fraud
rings companion cases.
Analyzing the data, finding the fraud patterns
Fraud cases can include false employment claims where nonexistent
employees are declared. In other cases, businesses are created by
the heads of fraud rings who collude with recipients who falsely
declare that their children are attending nonexistent child care
centers. Sometimes, criminals declare work schedules that are false
or shorter than the time amount claimed.
To combat fraud, LA County first needed a data integration solution
and a powerful analytical engine to bring together numerous
internal and external data sources to build and run predictive
models. With social network analysis and analytics, LA County can
predict which benefit recipients and service providers are most
likely to engage in fraudulent activity and create potentially
large fund losses.
Using predictive models and peer group analysis to detect anomalies
in the use of child care services, LA County developed high-risk
scores to decrease the number of false-positive cases assigned to
investigators. The system uses a predictive model to analyze social
networks and to assess the likelihood of child care fraud and
collusion in fraud networks in the Child Care Program. The social
network analysis also helped identify collusive fraud rings in
companion cases.
LA County uses SAS® Fraud Framework for Government and incorporates
SAS data mining technology with social network analysis, predictive
analysis, rules management and forecasting techniques. SAS®
Business Intelligence has also been used to create an information
portal where reports are housed and used to monitor and share
information on fraud cases. By identifying historical patterns of
fraudulent activity, investigators can focus on cases with a higher
probability of
fraud. These improved process efficiencies mean fraud investigators
have more time to review highrisk
cases.
Unraveling conspiracies, empowering investigators
SAS models have enabled DPSS' Welfare Fraud Prevention &
Investigations (WFP&I) staff
to identify and expedite the review of suspicious cases much
earlier than waiting on referrals from
contracted agencies or other referral sources.
DMS detected conspiracy groups much earlier, significantly reducing
the duration of fraudulent
activities. LA County mapped out a network of participants and
providers that visually displayed
their relationships. They looked at whether any given small network
fit into a larger scheme of
networks, in which participants are in collusion with other child
care providers. They identified
strong central nodes and, in one case, found a child care provider
serving many nodes of
participants colluding in fraudulent activities.
The aspect of the network that proved most valuable for fraud
investigators was the social
network analysis relationship display. This display shows a web of
complex relations linked, for
example, by common telephone numbers and addresses. Instant access
to this network of child care
recipients and providers saved fraud investigators innumerable
hours of casework preparation. “It
would take me months or years to uncover all of the relations
shown,” said one investigator.
“On one of my cases, with a single click of my mouse, I saw leads
to additional evidence that would
have otherwise taken weeks, possibly months to uncover. This
included evidence such as addresses
and names of potential unreported employers and potential
second-residence addresses. The system
also showed a connection between my suspect and two other suspects
on two other cases.”
Also, one investigator, who was nearing the conclusion of a
10-person conspiracy
investigation, ran the main suspect's name through the social
network analysis and discovered seven
potential additional co-conspirators that she would not have
otherwise discovered.
Strong return on investment, invaluable outcomes. From May 2011
through May 2015, the
following actions were initiated:
88 cases were referred to the district attorney for felony
prosecution.
941 DMS fraud referrals were initiated for investigation.
1,538 referrals to DPSS case workers were submitted for follow-up
action, of which 879
have resulted in one or more of the following:
o Fraud referrals for reasons other than child care fraud.
o Denial/termination/reduction of various public assistance
benefits.
o Overpayments.
o Medical share of cost.
Read the uploaded case and answer the following questions:
1.)What is the case about? Give the various components that make up the case.
2.)What was the problem to be solved in this case?
3.)Why was solving this problem very important?
4.)What Data Mining Tool was deployed to solve this problem?
5.)What data sources were used?
6.)How did the DM Tool find fraud patterns?
7.)How did the DM Tool unravel conspiracies and empower investigators.
Uncovering social service fraud saves millions, reinforces public trust Los Angeles County uses SAS® to detect...