Forum addresses impediments to data-sharing to detect fraud

Data analytics offers the opportunity to sift through the mounds of information government agencies collect, but oversight entities and law enforcement are challenged in their efforts to use the data effectively to address fraud, waste and abuse. That was the focus of a forum sponsored by the Government Accountability Office, the Council of the Inspectors General on Integrity and Efficiency, and the Recovery Accountability and Transparency Board.

Participants included an array of representatives of federal, state and local government agencies, as well as private entities.

Though participants pointed to the Center for Medicare & Medicaid Services' Fraud Prevention System as an example of harnessing data through predictive modeling and other analytics, the report says of government efforts overall, that "despite these efforts, the path to capitalizing on the potential of data analytics is not a clear one."

Participants said they're not always aware of all the data sources available for addressing fraud, that they'd like to see a database of known offenders and also pointed out that government program offices lack incentives to develop IT systems useful in oversight efforts.

They cited other challenges including:

  • An overwhelming amount of available data and difficulties setting priorities
  • The various legal implications of owning and maintaining data, including an array of regulations such as Freedom of Information Act disclosure requirements, HIPAA and others
  • Difficulty measuring the success of analytics programs

Participants also said that federal and state government agencies are not working from a single set of data standards, which makes integrating systems and interpreting the various data elements difficult.

Among the lessons learned, participants said that:

  • Having analytics tools isn't enough; it's crucial to have well-trained staff to perform data analysis, identify high-quality investigative leads and areas of greatest risk
  • Building support for analytics from top management down also is essential
  • Data and analytics operations must be consolidated into one location to enhance effectiveness and return on investment
  • Parties responsible for retaining and maintaining databases must be identified to ensure proper safeguards are in place to protect privacy

And they proposed actions including:

  • Addressing statutory challenges related to data access and use
  • Developing an ongoing community of practice focused on data-sharing challenges
  • Compiling a library of available open-source data analytics, modules, and tools

In June, CMS announced its anti-fraud efforts had recouped $14.9 billion under the Affordable Care Act. 

However, a report from the Office of the Inspector General, under the U.S. Department of Health & Human Services found the CMS predictive analytics program has its flaws that make it impossible to track inaccuracies.

To learn more:
- read the report (.pdf)

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