Paula Joshi wrote last month about how what we learn from the commercial world can be applied in government. She also promised to post a few examples. I’ll get that ball rolling.
This week SAS announced the availability of SAS Enterprise Case Management. While the announcement focuses more on the financial industry, government and health care are also mentioned. Basically, any industry that has significant exposures to fraud, waste abuse – and different agencies, departments or teams involved in detecting, preventing, recovering or prosecuting it - can make good use of ECM.
I encourage you to check out the release and accompanying blog post from our financial services fraud expert, Ellen Joyner. Features such as historical versioning, social network analysis integration, web service search and event notification can greatly enhance investigator efficiency and allow for seamless transition of a case from initial lead to final disposition.
In state government, it will be a powerful weapon against fraud and abuse. Let’s say a Medicaid fraud investigator is alerted by their analytics system or a tip hotline to a pattern of provider transactions that strongly indicate organized bilking of Medicaid. The investigator makes calls, pulls records, and organizes compelling evidence that it is indeed a case of fraud.
Once the Medicaid investigato determines that fraud has likely occurred, they are required torefer the case to the attorney general’s office. Without an enterprise case management system, the AG investigator would have to create a new case in another system and basically start all over again. With an enterprise case management system such as SAS ECM, the Medicaid investigator simply assigns ownership of the case to the AG’s office, and all data, case notes and documentation developed by the Medicaid investigator remain with the case file. This seamless transition allows the AG investigator to pick up where the Medicaid investigator left off and ensure that no information is lost in the transition.
New information uncovered by anyone is the investigation process is easily assimilated and a solid case is built against the fraudsters, more quickly putting an end to their crimes and sending them to prison.
If instead of criminal prosecution, the initial analysis indicated that a recovery action (in the case of abuse) or educational outreach (in the case of waste) is the more appropriate action, the case can just as easily be routed to other groups or functions for the correct follow up action. Each possible path can have unique set of activities and workflows to facilitate the ultimate resolution of the case. And most importantly, the workflows are configured to match the business process – not the other way around.
Fraud, waste and abuse - regardless of industry - is such a big problem, but it is also where so much money can be saved through prevention and recovery. ECM will be a powerful tool in that fight and I look forward to working with state government leaders, and my commercial colleagues at SAS, to figure out the best ways to wield it.
