Data Mining Solution 1 Using Data Mining Analytics to Support
Fraud Detection in CalWORKs Stage 1 Child Care Slide 2 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 Slide 3 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
Slide 4 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 Slide 5 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 Care 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
Slide 6 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
Slide 7 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 participants 10-year historical
data across Programs Utilization Process Slide 8 LA County Fraud
Framework DMS 8 Log On Page Slide 9 CASE VIEW SELECTION Case View
Select Slide 10 Triage View Slide 11 Investigator View Slide 12 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 Slide 13 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. Slide 14 Street Map View 14 Social
Network Map View Slide 15 Relationship Tree The Relationship Tree
tab shows a participants family, household members, and other
relatives. Users can adjust the time slider to view the tree over
time. Slide 16 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. Slide
17 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 Slide 18 Participant Detail Summary Report
in PDF Format 18 PDF Summary Report 18 Slide 19 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
