With more states moving toward Integrated Eligibility (IE) systems for state- administered subsidy programs, bad actors are using sophisticated computer programs and identity theft schemes to enter this “front door” to large programs like Medicaid, Temporary Assistance for Needy Families (TANF), and Women, Infants, and Children (WIC). 2015 improper payments for these programs vary from 3.2% in the Supplemental Nutrition Assistance Program (SNAP) to as high as 6.7% in Medicaid adding up to tens of billion of dollars nationally.
Pondera’s System, built “by investigators, for investigators”, offers an extremely powerful, yet easy-to-use system to combat fraud, waste, and abuse in Integrated Eligibility systems. It is currently being used in IE programs covering Medicaid, SNAP, WIC, TANF, the Low Income Home Energy Assistance Program (LIHEAP), the Children’s Health Insurance Program (CHIP), and more. Our integrated system spans fraud detection, investigation, and enforcement.
Detect Eligibility Fraud
Fraud Detection as a Service (FDaaS): Core detection system that includes over 60 Alerts, Prediction Models, and Geospatial Analysis Maps designed specifically for Integrated Eligibility systems. Validates businesses and beneficiaries. Searches for issues such as deceased, incarcerated, and out-of- state applicants, and shared program attributes such as emails, addresses, and IP addresses.
Fraud Risk Scorecards: Combine data matching services and behavioral flags to generate a fraud risk score for every beneficiary in your program. Stack rank all program actors to prioritize enforcement activities. Create custom scorecards based on your own investigative experience and apply that to the entire program database.
Investigate Eligibility Fraud
SuperSearch: Search the FDaaS database and integrated public records databases for information on beneficiaries, associates, affiliates, and more. Hyperlink to beneficiary profiles for more information such as fraud indicators, alert history, geospatial maps, and Google Street View of locations.
Network Analyzer: Visually explore associations and network linkages between and among businesses and beneficiaries. Use pre-built templates for issues such as corporate associations and clusters of beneficiaries. Save and share maps with fellow analysts and investigators.
Social Media Analyzer: Discover connections, associations, and investigative data through analysis of social network sites, blogs, and other on-line services. Save newly discovered links to your link analysis charts or open cases.
Fraud Caster: Capture interview and audit data and access key Pondera data while conducting investigations in the field. Securely obtain data when you need it rather than after you return to your office.
Enforce Eligibility Rules
Case Tracker: Create, manage, collaborate, and report on cases generated by Pondera or through tips or other automated systems. Add notes, documents, and images to your cases.
Intel Reports: Request in-depth investigative reports from Pondera’s Special Investigation Unit (SIU), staffed by certified fraud examiners, government program experts, and former law enforcement agents. Reports include behavioral, link, and social network analysis.
Executive Dashboard: Easily review the results of your detection and enforcement activities via a graphical management reporting system. Analyze your programs’ most frequent Alerts, associated dollar amounts, and trends over time.
Pondera’s entire suite of tools is fully integrated, passing data and leads between the detection, investigation, and enforcement modules. Your analysts and investigators access the system through a secure Internet Browser. Additional advantages of Pondera include:
- Rapid Deployments : Go live in as few as 120 days
- Cloud Infrastructure : No need to buy hardware or software
- Machine Learning : Identify emerging fraud trends with constantly improving algorithms
- Integrated Third Party Data : Validate identities, incarceration status, addresses, criminal histories, and more with pre-tested consumer and business databases