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To Face New Threats, We Need New Ways of Thinking

This is the first blog in a three part series exploring smarter counter fraud.

Technologies such as cloud computing, mobility, and web-based transactions have become pervasive in our private lives. For many of us, we are now demanding that government embrace those same technologies to create easier engagements, better service and provide information anywhere, anytime.

But as citizens demand improvements to service delivery, the risks of fraud, waste and abuse have increased for government. Today, there are more outlets for criminals to attempt to compromise, and obtain critical government information. Conspirators can use this data for fraudulent acts. And with the complexity of government services, without a progressive and proactive IT solution, agencies may never even know the depth of fraud, waste and abuse at an agency.

To help combat these issues, IBM recently launched its “Smarter counter fraud” initiative, to leverage IBM’s expertise in analytics to combat waste, fraud and abuse in the public sector. “Identity fraud impacted more than 12 million individuals in 2012, resulting in theft of nearly $21 billion, and each day the U.S. healthcare industry loses $650 million due to fraudulent claims and payments,” said an IBM press release.

Fraud is not just about financial issues – protecting customer and proprietary data is essential to building trust with customers. Government has looked at ways to leverage their data to spot abnormalities and stop tax fraud, medical fraud, improper government payments and insurance claims.

It’s important to remember that some government processes – like tax returns and healthcare submissions – leave behind both behavioral and transactional data. If agencies can understand the patterns, actions and processes behind these transactions, they can better understand their data as a means to combat fraud.

Today, organizations can take a proactive stance against fraud. By conducting in-depth analytical analysis, organizations can limit opportunities for fraud, and spot abnormalities much earlier in the process. In turn, agencies can transform transactional data into business value, leveraging their data to gain a holistic understanding of their customer needs, and reacting to market needs sooner.

Like most trends today, at the heart of this proactive approach is data. IBM has been at the forefront of counter fraud strategies. To help agencies, IBM has come up with four important procedures to improve counter fraud efforts

4 Imperatives to Counter Fraud

  • Detect: Apply analytical fraud models and rules in the business process to determine if an ‘action’ is potentially fraudulent before unnecessary deposits, withdrawals, transfers or payments occur.
  • Respond: Apply fraud insights to take action. Confidently differentiate legitimate actions while preventing or interrupting suspicious actions by responding immediately to criminal patterns and activities.
  • Investigate: Turn fraud intelligence into action. Perform and manage the deep inquires into suspicious activity that will support the compilation of evidence and provide the thorough analysis required to build more compelling cases for prosecution and recovery or denial of payment.
  • Discover: Leverage a rich set of analytic capabilities to identity suspicious activity by retrospectively reviewing historical data, analyzing patterns and building watch lists to identify individuals or organizations that might be conducting fraudulent activities.

Today’s world requires a new way to counter anticipate and react to fraudulent activities. Are you ready?

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The IBM Analytics Solution Center (ASC) is part of a network of global analytics centers that provides clients with the analytics expertise to help them solve their toughest business problems. Check out their Analytics to Outcomes group on GovLoop.

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