DOE OIG Cites Need for Data Analytics to Combat Fraud

Robyn N. Burrows ●

Last month, the Department of Energy (“DOE”) Office of Inspector General (“OIG”) issued a special report on the DOE’s use of data analytics to reduce the risk of fraud, waste, and abuse within DOE programs. As noted in our prior post (“More Cases and Expanded Data Analytics: A Closer Look at DOJ’s FY 2023 False Claims Act Statistics”), the Department of Justice has successfully used data analytics to identify and develop fraud cases, and the DOE OIG appears poised to adopt a similar approach—despite several implementation challenges.

Citing the significant influx of funds DOE has received through recent spending bills, the OIG report emphasized a need for the DOE to adopt data analytics and data-driven management to conduct oversight—moving away from a “pay and chase” model to a predicative, proactive approach to combatting fraud. However, the OIG found that DOE generally lacks the ability to perform comprehensive and timely analytics given that relevant data is maintained in a multitude of systems across the DOE complex. Without a coordinated approach for data standards, the OIG found that DOE’s ability to monitor contract costs and manage fraud risks is likely to be hampered.

Continue reading “DOE OIG Cites Need for Data Analytics to Combat Fraud”

The Government’s Use of Data Analytics to Identify Healthcare Fraud

Merle M. DeLancey Jr.

No one knows exactly how much fraudulent conduct costs the United States healthcare system. Some suggest it may cost Medicare, Medicaid, and private insurers $100 billion each year. Regardless of the exact amount, everyone agrees that the fraudulent activities result in more expensive healthcare and possibly the deprivation of healthcare for some.

The Department of Justice (“DOJ”) and agency inspectors general have recovered billions of dollars based upon demonstrated or alleged healthcare fraud. These cases and investigations, however, have generally been limited to a specific company or class of providers. Government investigators have struggled for years with how to identify fraudulent practices in government healthcare programs involving large volumes of claims. Continue reading “The Government’s Use of Data Analytics to Identify Healthcare Fraud”

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