Fraud Detection and Reduction Solutions

The wide-spread fraud problem:

Several Government agencies provide assistance to citizens in need. Examples are:

Estimates of fraud vary but there is agreement that billions of dollars are misappropriated and lost each year because of inappropriate claims and payments and the inability to gather, analyze, and take action across multiple fragmented agency information systems.

A Real-Life Case Study reporting excessive amounts of provider payments and reimbursements

A large North-east city disburses $2 billion annually to support 30,000 families in need of public assistance. Services are provided to families and individuals through 2,000 case workers and hundreds of providers. The City engaged Instaknow’s award winning “Human Intelligence Automation ™” software to integrate real-time information and automate business processes across multiple city agencies’ disparate backend systems, web-based portals, and client-server systems to detect and avoid misappropriation of funds while providing appropriate levels of financial assistance to those who are legally eligible to receive public funds.

The Instaknow integrated process automation solution, named CARES, integrates data from the following social services case management systems. CARES provides authorized case workers from all agencies an instant and comprehensive understanding of an individual (client) and the family's entire social services history, current status, eligibility, payments, and needs via a browser:

  1. Behavioral Health Special Initiative
  2. Office of Emergency Shelter Services
  3. Case Load Management
  4. Department of Social Services
  5. Forensic Intensive Recovery System
  6. City Prison System
  7. Department of Human Services
  8. Office of Mental Health Services
  9. Community Health Services
  10. Crisis Response Center
  11. Juvenile Justice System
  12. Provider Payment System

Instaknow’s automated intelligence capabilities greatly reduce the costly, time-consuming problems that result from fragmented, hard to reach information and protracted manual operations. CARES advances caseworker productivity, improves responsiveness to clients, drastically cuts decision times, ensures compliance to state and federal laws, guidelines and limits and avoids improper decisions resulting from fragmented information, late information, or simply, no information.

The Fraud Problem and Instaknow’s Solution

Earlier, because the individual agency case management systems were not integrated with the City’s Provider Payment System, no automated comparisons, validations or audits of claims, approvals and payments could be accomplished without intensive manual efforts fraught with errors and omissions. Since Instaknow’s integration, a real-time cohesive view of all visits to providers and payments made to an entire family and individuals is available in seconds to case workers and auditors. Since Instaknow leaves all data in each agency’s original system of record, the City enjoys the benefits of a “Virtual Data Warehouse” WITHOUT the cost of deploying a complex Business Intelligence (BI) package! Instaknow deploys sophisticated decision support solutions without writing code and without change to existing systems.

Rapid Deployment Means Rapid Results and Rapid ROI

The client City selected Instaknow’s patented BPM platform after evaluating other BI and integration approaches. Instaknow’s “Human Intelligence Automation ™” provides benefits far beyond those gained through a typical Business Intelligence (BI) solution by enhancing it with business rule driven Business Process Management while eliminating the need for a very complex, protracted, and expensive multi-year legacy system re-programming effort in order for each system to be XML-enabled. Additional agencies and systems (e.g. Child welfare, Adoption) will be added to Instaknow’s integrated solution shortly.

The first production phase was deployed in just eight months, at a fraction of the cost and time of conventional approaches that would have required a massive multi-system, multi-year XML programming effort. Instaknow’s innovative Process Automation solutions will be equally effective in other city, state and federal government agencies.