Uncovering social service fraud saves millions, reinforces public trust

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 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. By doing so, they've helped 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. Social network analysis 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 Child Care Program. Social network analysis also helped identify collusive fraud rings in companion cases.

LA County uses the 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 high-risk cases.

Saving millions of dollars

SAS models have enabled DPSS' Welfare Fraud Prevention and Investigations staff to identify and expedite the review of suspicious cases much earlier than waiting on referrals from contracted agencies or other referral sources.

And, SAS Social Network Analysis functionality 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 relationship network 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.

Moving forward, LA County hopes to expand its reviews to improve in a variety of areas:

  • Early detection of suspicious cases.
  • Early detection of suspicious child care providers.
  • Detection of previously unknown suspicious participants.
  • Detection of previously unknown suspicious child care providers.
  • Increased investigatory efficiencies.
  • Detection of collusive behavior.
  • Interagency collaboration.

Challenge

One of the nation's largest county governments needed to uncover systemic fraud in its delivery of social services to economically disadvantaged citizens.

Solution

Benefits

Investigators can spot more cases of fraud sooner, resulting in fewer losses, lower investigative costs and greater public confidence.

Los resultados que se ilustran en este artículo son específicos a las situaciones, modelos de negocios, datos aportados y entornos de cómputo en particular que se describen aquí. Cada experiencia del cliente de SAS es única basada en variables de negocios y técnicas y todas las declaraciones se deben considerar no típicas. Los ahorros, resultados y características de desempeño reales variarán dependiendo de las configuraciones y condiciones de los clientes individuales. SAS no garantiza ni augura que todos los clientes lograrán resultados similares. Las únicas garantías aplicables a los productos y servicios de SAS son aquellas que se estipulan en las declaraciones de garantía explícitas en el contrato por escrito relativo a dichos productos y servicios. No se debe considerar que nada de lo aquí mencionado constituye una garantía adicional. Los clientes han compartido sus éxitos con SAS como parte de un intercambio contractual convenido o resumen de éxito de proyectos tras una implementación exitosa de software de SAS. Los nombres de marcas y productos son marcas comerciales de sus respectivas compañías.

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