Current Situation
Despite agency efforts, fraud, waste, and abuse spending continues to impact national government. In the United States, Medicare and Medicaid improper payments were almost $85 billion in FY18. Beyond pay, chase, and recover, federal agencies are working to stop these payments, but bad actors may be a step ahead of government.
Goals and Objectives
Ensure the accuracy of benefits and payments and reduce the annual amount of improper payments.
Technology Deployed
Hardware: Cloud computing server and storage
Software: Analytics, fraud detection, AI and generative AI to flag out-of-the-ordinary transactions and identify high-risk attributes and monitor suspicious transactions, dashboards, and security
Services: Blockchain as a service, SOC, and XDR
Use Case Summary
Agencies can move from recovery of funds to prevention of improper payments through the deployment of cloud-based lists of individuals and entities excluded from receiving payments or barred from doing business with the government. This can also be done with analytics and generative AI to catch suspicious benefit claims and with federated data hubs with the appropriate access controls to securely share, merge, combine, and analyze disparate data (structured, unstructured, and semi-structured data and metadata) across multiple agencies.