Government Benefits Programs Need a Triage Makeover

How agencies can rein in improper payments.

In October, the Government Accountability Office released a report finding that the federal government racked up more than $124 billion in improper payments in 2014 – a $19 billion increase over the previous year. Improper payments – funds issued to the wrong recipient or in the wrong amount, or issued with insufficient documentation – is clearly a serious governmentwide problem.

According to GAO, a number of strategies, such as implementing preventive controls and identifying the root causes of improper payments, will be critical for agencies to take corrective actions.

We hear a lot about fraud, waste and abuse in government programs. Across the country, stories of individuals or groups scamming the government make news headlines almost daily. Every year public benefits programs lose billions of dollars to fraud. Although fraud and improper payments are not the same, the end result is:  Both degrade the integrity of government programs and compromise citizens’ trust in government. Ensuring that benefits and services reach legitimate recipients who depend on these programs is priority No. 1.

Agencies obviously would prefer to prevent payments to fraudsters in the first place and not have to use valuable resources to recover such funds, but they have a daunting task. More than 150 million Americans – comprising an estimated 49 percent of U.S. households – receive benefits from one or more government programs.

Determining benefits eligibility can be difficult and time-consuming given the sheer volume of recipients. The potential for identity theft and fraud is high due to the frequency of incomplete or inaccurate information throughout the entitlements lifecycle. It is understandable that government caseworkers are overwhelmed by the volume of information that needs to be verified.

Consider this: The vast majority of improper payments are due to unintentional errors. These errors can stem from a simple data entry mistake, or a lack of documentation to support a beneficiary’s eligibility. Agencies can reduce errors through vigilance and early detection, and many are realizing that the right technology and data analytics tools can be a formidable deterrent.

By using adaptive case management, agencies can be proactive in triaging their workload on the front end. Instead of dealing with cases in the order they are received, ACM relies on high-performance analytics to direct investigators toward the cases that need more review and scrutiny. Agencies are able to group cases into risk categories. Cases that are low- or no-risk are pushed through without delay, but cases that show signs of trouble or present risk factors will be automatically flagged and alerts are shared with investigators. Suspicious cases will undergo a deeper level of investigation such as further verification of address or citizenship.

ACM’s automated workflow process gives investigators more time to research more complex cases and uncover schemes and fraudsters – before any payment is made. Because ACM can work with existing case management systems, there’s no need to rip-and-replace. By optimizing and prioritizing cases and workload, agencies can tackle the enormously complex challenges of fraud and improper payments with more consistency, efficiency, accuracy and accountability.

Other case management challenges, including a lack of communication between investigative departments, hinder vital information sharing and set the stage for duplication of effort and error. Limited reporting and management oversight, and inconsistent processes and workflows also are major problems.

ACM’s risk-based continuous evaluation capability, coupled with the power of data analytics (e.g., on-demand access to meaningful information from external data sources and historical records) enables agencies to experience rapid resolution of investigations, increased employee productivity and job satisfaction, and a reduction in case appeal rates.

The result?  Reduced costs and better fraud prevention.

With increased attention on delivering greater value to the public at a lower cost, agencies must arm themselves with the right combination of technology and data analytics in order to work better, smarter and faster. ACM can reduce improper payments and fraud, enabling agencies to save billions of dollars and improve mission success across government.

Glenn Edelschein is director of Strategic Initiatives at SAS Federal.

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