The U.S. Postal Service Office of Inspector General (USPS OIG) initiated fraud investigations based mainly on tips they received. To be more proactive, the agency sought to create a systematic process to provide investigative analysts with data-driven leads based on known fraud, waste, and abuse schemes.
Elder Research partnered with the USPS OIG to customize a solution to generate leads based on risk indicators and anomaly detection for suspicious Postal contracts and medical claims. The model’s results were delivered in an easy-to-use visualization tool called RADR (Risk Assessment Data Repository). The tool enabled analysts and investigators to access and visualize data on high-risk contracts and medical claims.
Leads generated by the contract fraud model proved to be 74% actionable; 23 out of 31 highest scored contracts showed evidence of fraud, waste, and abuse. RADR made the healthcare model results more visual and interactive, which led to the opening of 113 investigations and aided in over $11 million in recoveries, restitutions, and cost avoidance in the first year, reduced hours spent on a case by 30% and increased dollars returned per case by 35%.