SPSS Industry Solutions | Government | State and Local

Fight Fraud, Waste, and Abuse with Predictive Analytics

Fraud, waste, and abuse weaken the effectiveness of government programs. Healthcare programs like Medicare and Medicaid and other social support programs are common targets, since they involve so many participants and individual transactions. Taxpayers end up paying the bill for funds that are lost to fraud, waste, or abuse—decreasing citizens’ confidence in government’s ability to manage crucial services and valuable public funds.

In combating fraud, waste, and abuse, predictive analytics
solutions from SPSS Inc. provide valuable assistance. Predictive analytics technologies enable organizations to "connect the dots" faster in order to anticipate and even prevent instances of fraud, waste, and abuse. Agency investigators can set priorities and dedicate staff and other resources with greater confidence that they are looking into cases most likely to lead to the recovery of significant monetary amounts.

Predictive analytics makes it feasible for analysts to:

Detect errors and improper payments in the administration of program benefits
Uncover abuse in credit- or purchase-card programs
Improve the monitoring of contractor performance

Healthcare agencies use SPSS predictive analytics to detect fraudulent claims or billing. Agency analysts are able to predict which claims are likely to be fraudulent, enabling auditors to concentrate on the right claims and recoup lost revenue. Predictive analytics can help with a variety of investigations, including those covering:

Beneficiary-sharing practices that may indicate inappropriate billing among agencies
"Up-coding" of procedure codes, whereby alternate diagnosis codes are used because they represent a larger reimbursement
Unusual claim sequences by a provider over designated time periods

Improve results with proven solutions

Predictive analytics solutions from SPSS are used by government agencies worldwide to analyze massive amounts of data with powerful techniques that uncover subtle patterns and associations and identify anomalies. In contrast to rule-based detection approaches, SPSS predictive solutions "learn" from the data, building models or tables of relationships that consider all the data elements and significant relationships. Such models remain valuable, even as patterns in the data change. And SPSS offers solutions to help centralize the storage and management of predictive models, further increasing the effectiveness of efforts to eliminate fraud, waste, and abuse.

To learn more about how SPSS solutions help defense agencies combat fraud, waste, and abuse, contact an SPSS representative.