Georgia health department uses analytics to stop fraud in WIC program

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Women and children in need rely on Georgia's WIC program for nutritional assistance, but fraudsters also try to take a bite of the apple. Image by US Dept of Agriculture

In many grocery stores throughout the country, the acronym “WIC” accompanies a number of the food items on the shelves. The letters stand for the federal “Women, Infants and Children” program that provides nutritional food to pregnant women and their young children who are in need.

While this is a federal program, each state is responsible for its administration. This includes screening potential candidates, administering vouchers that can be exchanged for food, and monitoring the program for fraud.

“This program has become a critical way to help lower-income families get nutritious food for mothers and their children,” said Chavis Paulk, analytics and cost containment manager for the Georgia Department of Public Health. “It is also a program that people try to exploit.”

WIC prohibits participants from selling their vouchers. The fear is that participants do not use the vouchers for food, but instead sell them at a reduced price and use that money for other things. There is also the practice of using the vouchers to purchase expensive items, and then selling those items instead of using them.

These practices go against the spirit of the program, and ultimately hurt the women and children it is intended to help. To help crack down on fraud within the program in Georgia, Paulk and his team turned to analytics.

As he explained during the SAS Government Leadership Forum in October, Paulk and his small team used techniques like clustering to help highlight cases of potential fraud that could be reported to his department’s inspector general.

For example, Paulk said WIC participants typically use their vouchers at a store within a few miles of their home. His system would look at the distance that vouchers were redeemed to see if there were any outliers.

“It would not make any sense for a person to drive 300 miles to use their voucher,” Paulk said. “If we see someone consistently uses their vouchers a long way from home, or in a pattern that does not make sense, there is a high chance that they could be trying to defraud the system.”

Along with using analytics to monitor the program’s participants, the Georgia Department of Public Health also looked at the stores where the vouchers were accepted. Businesses that accept lots of vouchers from people registered in different parts of the state may be taking part in a larger scam.

Paulk said that analytics greatly helped his office increase the number of referrals it made to its inspector general. The number of referrals was so great thanks to the analytics system, the office ultimately had to recalibrate what is considered successful.

“We’ve seen a tremendous amount of change,” Paulk said. “Before, it was up to our small staff to look at data and try to find these anomalies. Analytics makes the process so much easier and allows us to identify more cases for further investigation to reduce fraud.”

This is a prime example of how a government agency is working to fight fraud within its benefits programs. With International Fraud Awareness Week upon us, it is important to highlight stories like these; to provide best practices that other agencies can implement to help in their own programs.

If you would like to hear from other government professionals who are using analytics to battle areas such as fraud, opioids, workforce issues, terror financing and more, please visit www.sas.com/glf-virtual to watch the virtual sessions from the SAS Government Leadership Forum.

 

 

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Paula Henderson

Vice President, US Government practice

As Vice President of the US Government practice at SAS, Paula Henderson is responsible for leading a team that brings the power of SAS analytics to all 15 US federal government departments, all 50 state governments, and many counties and municipalities across the US. Paula believes analytics can help government provide high-quality services, while maximizing resources and budgets, and ultimately improve the lives of citizens. By decreasing fraud, waste and abuse, improving public safety and healthcare outcomes and, most importantly, protecting children, analytics can be applied across federal, state and local agencies to make our communities better and safer places to live and do business.

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