Data Mining Solution

voltaireblingData Management

Nov 20, 2013 (3 years and 10 months ago)

96 views

Data Mining Solution

1

Using Data Mining Analytics

to Support
Fraud
Detection in

CalWORKs

Stage 1
Child Care

2


Data mining is a reiterative process of selecting, exploring
and modeling large amounts of data to identify meaningful,
logical patterns and relationships among key variables.




Source:

Data Mining 101: How to Reveal New Insights in Existing Data to Improve Performance

Insights from a webinar in the SAS Applying Business Analytics Series

Originally broadcast in June 2010

Data Mining Technology

3

DPSS’

Data

Mining

Solution

(DMS)

is

a

computer

application

that

employs

pattern

detection

and

predictive

analytics

to

detect

and

prevent

fraud

in

public

assistance

programs,

such

as

our

CalWORKs

Stage

1

Child

Care

Program
.




A Board Motion introduced
by Supervisor Antonovich on
May
29, 2007,
provided the
Department
of Public Social
Services (DPSS) the vision to utilize
cutting edge technology,
such as data mining and predictive analytics, to ensure and maintain the integrity of the
County's public assistance
programs.



A

successful

pilot

was

completed

in

2008

which

evaluated

the

effectiveness

of

using

data

mining

technology

to

detect

potential

fraud

in

the

CalWORKs

Stage

1

Child

Care

Program
.



The

DMS

Agreement

was

approved

by

the

Board

on

December

22
,

2009
,

for

SAS

Institute

Inc
.

(SAS)

to

design,

develop

and

implement

the

data

mining

technology

for

Los

Angeles

County

to

target

fraud

in

the

CalWORKs

Stage

1

Child

Care

Program
.




The

DMS

Application

was

implemented

on

May

2011

by

DPSS

to

target

fraud

in

the

CalWORKs

Stage

1

Child

Care

Program
.


The

Board

Approved

an

Amendment

to

the

DMS

Agreement

on

May

15
,

2012

to

extend

the

data

mining

technology

to

In
-
Home

Supportive

Services

(IHSS)

Program
.






Project Background



DMS

Application

is

hosted

in

Cary,

North

Carolina

by

SAS

OnDemand



The

SAS

Fraud

Framework

tracks
:


CalWORKs

Stage

I

Child

Care

Participants

with

children

requesting

assistance

from

the

County
;


Providers

that

care

for

children

while

the

parent

or

guardian

go

to

work

or

school
;

and



Employers

on

record

providing

employment

for

the

participants

who

attempt

to

defraud

the

County

of

Los

Angeles

by

obtaining

payment

for

falsified

services
.



Using

state

of

the

art

data

mining

techniques

the

DMS

application
:


Prioritizes

referrals

from

Alternate

Payment

Program

agencies

(APPs)


Consolidates

data

for

investigations


Shows

networks

among

providers

and

participants


Streamlines

/

optimizes

searching

of

County

data

sources


Capable

of

integrating

with

existing

workflow

and

case

management

systems



Displays

results

using

the

advanced

visualization

application



Uses

statistically

designed

risk

measures

to

predict

collusion

activities

4

Project Objectives and Key Milestones

5

Data Preparation Efforts

Historical
data from 2001 to Present

Data was (cleaned/matched/consolidated/geocoded
)
monthly from
DPSS and
external data sources to generate dozens of variables for data mining models
including:

Data Focus:
Participant
and Provider

CalWORKs

Stage 1 Child Care


Child care utilization, request and provider files


Welfare
-
to
-
Work activity tables from the GEARS system


Child care licensing files


LEADER Case and Individual tables
for
participant records

Data includes known cases of fraud and alleged fraud


LEADER Fraud cluster tables
to identify participants referred/prosecuted for


Child
C
are
and other fraud
types

External Data Sources


State
employment, employer and
Income& Eligibility Verification System (IEVS) &
New Hire (NHR) files


Dun and Bradstreet employment file


In
-
Home Supportive Services (IHSS) participant
and provider files





Project
Data Sources

6

Risk Assessment


Rules/Pattern
Recognition


Anomaly Detection


Predictive Model


Hot List
-

(e.g., Providers & Employers with known fraudulent activity)


Social Network Linkages

Operational Outcome


Prioritized
by
Alert score


Monthly
High Risk
Report


Drill
-
down
into case
detail


Further drill
-
down
into
Alert detail


Launch
into other ad
-
hoc
analyses

Alert
Score


Base score


Plus or minus depending on value of components

Anomaly Detection

7

Triage View


High

risk

Alerts

are

generated

based

on

the

comparisons

between

CalWORKs

Stage

1

Child

Care

cases

and

the

typical

profile

of

fraudulent

CalWORKs

cases


Designated

Triage

Workers

(DTWs)

are

assigned

to

conduct

comprehensive

case

reviews

based

on

these

Alerts


Referrals

are

initiated

to

Welfare

Fraud

Prevention

&

Investigations

(WFP&I)

Section


Case

action

reviews

result

in

one

or

more

of

the

following

outcomes
:

termination

of

benefits,

overpayments,

reduction

in

benefits,

share

of

cost

and/or

fraud

referral

Investigator View


DMS

provides

tools

and

the

capability

to

the

DPSS

WFP&I

team

to

assist

in

their

detection,

prevention,

and

investigation

of

fraud

in

the

CalWORKs

Stage

1

Child

Care

Program


The

Social

Network

Analysis

allows

WFP&I

to

identify

suspicious

cases

for

preliminary

earlier

investigation


Provide

access

to

participant’s

10
-
year

historical

data

across

Programs



Utilization Process

LA County Fraud Framework


DMS


8

Log On Page

CASE VIEW SELECTION

Case View Select

Triage View

Triage View

Investigator View

Investigator View

12

User Interface Participant Details

The

Participant

Detail

pane

provides

a

quick

view

at

the

participant

case

record

information

related

to

residential

address,

family

members,

providers,

employment,

source

income

and

benefits

and

prior

welfare

fraud

historical

records
.

Participant Detail Page

Timeline Graph

Timeline Tab

The

Timeline

tab

is

a

graphic

representation

of

the

data

from

the

Provider,

Address,

Employment,

Component,

Income

and

Benefits,

and

DPSS

Actions

tabs

This

graph

provides

a

brief,

color
-
coded

view

of

each

data

source,

as

well

as

a

quick

method

for

seeing

when

each

event

occurred
.

Street Map View

14

Social Network Map View


Relationship Tree

Relationship Tree

The
Relationship Tree

tab shows a participant’s family, household members, and
other
relatives. Users
can adjust the time slider to view the tree over time.

Risk Assessment

Risk Assessment

Risk Assessment

tab contains a list of key fraud indicators for a
participant. The
tab contains two parts: the
Predictive Model

section and the
Triggers

section.

Social Network Analysis

17

The

Social

Network

Analysis

provides

a

graphical

view

of

the

Participant

case

record

centered

on

the

graph

with

all

the

connections

within

the

database

of

other

Participants,

Providers,

Employment

activities

and

Phone

Number

connections

to

the

CalWORKs

Stage

1

Child

Care

Participant
.


Social Network Example

Legend

Participant Detail Summary Report in PDF Format

18

PDF Summary Report


18

19

Holistic Approach to Program Integrity


From May 2011 through July 2013, the following actions were initiated:



* 28
Cases have been referred to the District Attorney for felony
prosecution



* 405
DMS fraud referrals initiated for investigation


Triage
-
Initiated: 311


WFP&I
-
Initiated: 94




* 753
Referrals to DPSS case workers for follow up action resulting in:


Fraud referrals for reasons other than child care fraud


Denial/Termination/Reduction of various public assistance benefits


Overpayments