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WHT/082311 Fighting Fraud, Waste and Abuse with Cross-Jurisdiction Contributory Systems Monty Faidley, Director of Market Planning Proprietary and Confidential.

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Presentation on theme: "WHT/082311 Fighting Fraud, Waste and Abuse with Cross-Jurisdiction Contributory Systems Monty Faidley, Director of Market Planning Proprietary and Confidential."— Presentation transcript:

1 WHT/ Fighting Fraud, Waste and Abuse with Cross-Jurisdiction Contributory Systems Monty Faidley, Director of Market Planning Proprietary and Confidential

2 WHT/ Government Benefits Programs Impact Everyone 2 108,592,000 people receiving benefits in the United States $1.8 Trillion annual cost Estimated $90 Billion in Improper Payments Key Issue: Reducing Fraud, Waste, and Abuse

3 WHT/ What is a Contributory System 3 Shared pool providing insights Similar stakeholders contributing similar information Agreed upon usage rules Adding one source gives immediate benefit to all participants To get, you must give Give a little, Get a lot

4 WHT/ Examples of Contributory Systems 4

5 WHT/ Examples of Contributory Systems 5

6 WHT/ Contributory System: An Inter-Agency Example 6 Agency Sources IDENTITY DATA J. Simmons Miami, FL East 3 rd St Name: Address: Address 2: XXX SSN: IDENTITY DATA Jack Simon E Third Name: Address: Address 2: -5555SSN: IDENTITY DATA Jackson Simons Miami, FL 40 W. Main Ave Name: Address: Address 2: XXX SSN: DOR DMV HHS Consolidated IDENTITY DATA Jackson 72 East 3 rd Street Simmons First: Last: Address: MiamiCity: FL, /14/1972 XXX State/Zip: SSN: DOB: DL #: Simmons Inc. (999) Company: Phone: Single View of Identity Information Across the State Services Identity Proofing Risk Assessment Information Exchange No Yes Deceased: Incarc: Resident: No Corrected

7 WHT/ Contributory System Benefits in Fraud, Waste, and Abuse 7 Improve Program Integrity Identify known high risk activities and individuals Verify and authenticate identity information in online transactions Resolve information across agencies Improve Decision Timeliness Required information is available at your fingertips Updated in real time or near real time Improve Accuracy Identify relevant, reliable information that improves decision-making Verify eligibility information before determination is made

8 WHT/ Contributory Systems: Common Challenges 8 Who owns the data? What are the Department regulations on data usage? Data sharing? What are your State laws governing data sharing and privacy? What Federal Regulations for data sharing exist that impact your Agency? Legal and Regulatory Issues Clearly define Permissible Use – “Who is allowed to access this information?” Clearly define Permissible Purpose – “What are they allowed to do with this information?” Work closely with Policy, Regulators, and Lawmakers Best Practices

9 WHT/ Contributory Systems: Common Challenges 9 Does your application process include permission to use an individuals data for this purpose? How will the system be viewed by individuals? The press? The ACLU? How do you minimize sharing of Personally Identifiable Information (PII)? Privacy Identify ways to secure individual approval through language on applications or online click-through Provide an opt-in / opt-out function for individuals Avoid terms like “profiling”, “dossiers”, “surveillance”, or “total information awareness” Best Practices

10 WHT/ Contributory Systems: Common Challenges 10 Security Track, Report, and Audit data access at the data element layer Follow federal and industry best practices for physical, network, and server security. Patch often! Limit access, at the data element layer, to a need-to-know basis Best Practices What is the risk of storing contributed data in a single place? Who owns the liability for a data breach? Is your cyber security up to the task?

11 WHT/ Contributory Systems: Common Challenges 11 How big will this system grow? Can it handle millions of records? Billions? Trillions? How do you securely contribute data to the system? How do you secure access to the data? How do you track, audit, and report on compliance? Technical Implications Use proven solutions and platforms Leverage cloud-based technology Use open source where possible Follow industry standards Best Practices

12 WHT/ Starting a Contributory Project 12 Where Do I Begin? Create a Vision – what problem do you want to solve? Start Networking – build a team of stakeholders Seek out Industry Partners with contributory experience Pick a Leader Look to the Future - accept that the process will take time

13 WHT/ Questions Proprietary and Confidential - 13 Confidential and Proprietary. Copyright © 2014 LexisNexis. All rights reserved. Monty Faidley, Director of Market Planning LexisNexis Risk Solutions About LexisNexis Risk Solutions LexisNexis® Risk Solutions (lexisnexis.com/risk) is a leader in providing essential information that helps customers across all industries and government predict, assess and manage risk. Combining cutting-edge technology, unique data and advanced scoring analytics, we provide products and services that address evolving client needs in the risk sector while upholding the highest standards of security and privacy. LexisNexis Risk Solutions is part of Reed Elsevier, a leading publisher and information provider that serves customers in more than 100 countries with more than 30,000 employees worldwide. Bridger Insight, InstantID and FraudPoint services are not provided by “consumer reporting agencies,” as that term is defined in the Fair Credit Reporting Act (15 U.S.C. § 1681, et seq.) (“FCRA”) and do not constitute “consumer reports,” as that term is defined in the FCRA. Accordingly, Bridger Insight, InstantID and FraudPoint service may not be used in whole or in part as a factor in determining eligibility for credit, insurance, employment or another purpose in connection with which a consumer report may be used under the FCRA. Due to the nature of the origin of public record information, the public records and commercially available data sources used in reports may contain errors. Source data is sometimes reported or entered inaccurately, processed poorly or incorrectly, and is generally not free from defect. These products and services aggregate and report data, as provided by the public records and commercially available data sources, and are not the source of the data, nor are they comprehensive compilations of the data. Before relying on any data, it should be independently verified. LexisNexis, Lexis, Nexis and the Knowledge Burst logo are registered trademarks of Reed Elsevier Properties Inc., used under license. InstantID and FraudPoint are registered trademarks of LexisNexis Risk Solutions Inc. Bridger Insight are trademarks of LexisNexis Risk Solutions Inc. Other products and services may be trademarks or registered trademarks of their respective companies. LexisNexis and the Knowledge Burst logo are registered trademarks of Reed Elsevier Properties Inc., used under license. Other products and services may be trademarks or registered trademarks of their respective companies. Copyright © 2013 LexisNexis. All rights reserved.


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