Kusserow’s Corner: GAO Report on Data Analytics for Oversight and Law Enforcement

In the health care sector everyone has seen the results of increased use of data analytics by the Office of Inspector General (OIG) and CMS contractors to root out fraud, waste, and abuse. This trend continues to expand across programs of the federal government. Earlier this year the General Accountability Office (GAO), Council of the Inspectors General on Integrity and Efficiency (all the federal Office of Inspectors General), and the Recovery Accountability and Transparency Board convened a forum with the purpose of exploring ways in which oversight and law enforcement agencies use data analytics to assist in the prevention and detection of fraud, waste, and abuse, as well as identifying the most-significant challenges to realizing the potential of data analytics and actions that the government can take to address these challenges. HHS OIG played a significant role in planning and conducting this forum. The GAO has now issued a report on the results of a conference. They prefaced their report by noting that sharing data, knowledge, and analytic tools can assist government agencies in this effort. However, while there is a tremendous amount of information the government can use in preventing and detecting fraud, waste, and abuse, using and leveraging these data can be challenging.

This report summarizes the key themes that emerged from the discussion in the forum. Specifically, the report discusses the challenges and opportunities in (1) accessing and using data and (2) sharing data. The participants noted, among other things:

  1. Consolidation of data and analytical operations can enhance the return on investment
  2. Using predictive analytics to identify fraudulent claims before payment is preferable
  3. Garnering agency support in using data analytics is key to success
  4. Lack of incentives to design information-technology systems to facilitate the identification of fraud, waste, and abuse
  5. Lack of incentives by program offices to share data with oversight community
  6. Data available can be overwhelming in volume for oversight and law enforcement
  7. Various legal implications of owning and maintaining data
  8. Measuring successes of analytical program is difficult
  9. It is critical to have knowledgeable and skilled staff to do the analytical work
  10. Varying data standards across government creates obstacle to the sharing

In addition, participants identified next steps to address these challenges and capitalize on opportunities. The three sponsoring organization agreed to compile a consolidated directory of data sources to increase awareness; compiling a library of available open-source data analytics, modules and tools; developing an ongoing community of practice focused on data-sharing and examining the existing statutory framework for to determine whether changes are need to eliminate barriers for data analytics for enforcement agencies to carry out their missions. What this all means is that it is reasonable to see the trend of using data systems and technology in support of oversight and law enforcement will continue at an ever increasing rate.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2013 Strategic Management Services, LLC. Published with permission.