SAS® Detection and Investigation for Government Features
- Provides a data model that integrates data from any source – regardless of system or format – to give a comprehensive view of each individual or business.
- Lets you automate, manage and control the entire data integration process via an administrative GUI, and restrict data access at the record and element level through a powerful security model.
- Manages data issues by integrating, standardizing and improving the quality of the data used to make critical decisions. Uses fuzzy matching to improve identity resolution across data sources that don’t share a unique identifier.
- Consolidates historical data from internal and external sources – claims systems, watch lists, third parties, unstructured text, etc.
- Eliminates or reduces redundant or inconsistent data with the solution’s built-in data quality tools.
- Seamlessly integrates with existing payment integrity solutions, including case management systems, overpayment recovery vendors, audit control systems, etc.
Advanced analytics with embedded AI and machine learning
- Provides a broad set of modern statistical, machine learning, deep learning and text analytics algorithms from within a single environment
- Enables you to improve fraud models by testing different approaches in a single run, and comparing results of multiple supervised learning algorithms with standardized tests.
- Provides an array of analytical capabilities, including clustering, different types of regression, random forests, gradient boosting models, support vector machines, natural language processing, topic detection and more.
- Continuously updates and improves models based on prior output results.
Rule and analytic model management
- Provides prepackaged heuristic rules, anomaly detection and predictive models, so you can harness the power of advanced analytics right out of the box.
- Lets you create and logically manage business rules, analytic models, alerts and watch lists.
- Enables you to customize analytical models to identify fraud, waste and abuse not found by existing business rules.
- Enables easy management of the deployment, aggregation, scheduling, suppression and routing of similar rules across multiple factors, such as parties, data sources and business lines.
- Lets you run groups of rules and models alone, in parallel or at different times (intraday, daily, weekly, monthly, etc.).
- Facilitates collaboration with other business units (e.g., member cost management, chronic condition management, operations analytics) on model development.
Detection and alert generation
- that employs a combination of analytic techniques to determine the likelihood of fraud.&
- Scores transactions in real time with an online scoring engine that uses a combination of business rules, anomaly detection and advanced analytical techniques to determine the likelihood of fraud.
- Analyzes historical data to provide a deep understanding of behavior, allowing you to determine if a payment makes sense in the context of past actions.
- Combines alerts from multiple monitoring systems, associates them with common individuals and provides a more complete perspective on the risk of particular individuals or groups.
- Prioritizes the investigative order of alerts by scoring them in real time, based on specific characteristics.
- Automatically routes alerts to appropriate team members based on user-set rules and requirements.
- Displays all evidence for each case on a dashboard that you can customize to accommodate your investigative unit's processes.
Social network analysis
- Provides a unique network visualization interface that lets you go beyond transaction and account views to analyze related activities and relationships at a network dimension, and identify linkages among seemingly unrelated events.
- Enables you to produce complete dossiers of networks surrounding a case, and gain fast access to full details on all related parties and networks.
- Produces independent and combined fraud scores, so you can assess overall risk on an individual, transaction or network basis.
- Increases investigator effectiveness by enabling investigators to merge and delete network entities, and add annotations (text and images) to specific entities in a network.
- Provides time slider functionality, which enables you to see how activity in a network develops over a time horizon.
Search and discovery
- Enables free-text, field-based or geospatial searches across all data (internal and external).
- Lets you refine searches using interactive filters and facets that are customized for your SIU team.
- Provides an intuitive interface that lets you construct complex queries without the need to understand specific syntax. For example, you can use fuzzy searching, proximity searching and field boosting while restricting searches to specific entity types, fields, comments or insights.
Intelligent case management
- Systematically facilitates investigations using a configurable workflow.
- Stores all information pertinent to a case, including detailed investigation information – e.g., interview notes and evidence for criminal or civil prosecution, restitution and collections.
- Assesses overall fraud exposure, including losses due to fraud as well as fraud detected or prevented.
Flexible deployment options and analytical services
- Provides highly secure hosting for your sensitive information. SAS is certified and experienced in handling sensitive medical (HIPAA), financial/personal (PII) and tax (IRS publication 1075) data.
- Utilizes a single point of contact and ownership for any system-related issues.
- Enforces and administers user-level security policies based on your specific requirements.
- Enforces a comprehensive and verified disaster-recovery plan.