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Using AI to Protect Veterans from Fraud

The Challenge: As Fraud Grows More Sophisticated, Anti-Fraud Programs Must Follow Suit

VBA has historically used analytical methods to detect fraudulent activities aimed at veterans’ compensation, pension, and other benefits payments. Unfortunately, over time these methods were becoming less effective than they were in the past. To stay ahead of fraudsters who are embracing more advanced tactics and technologies, VBA needed to respond in kind.

Understanding this, VBA’s leaders partnered with Ä¢¹½ÊÓƵ Allen to modernize the agency’s approach to fraud, waste, and abuse prevention.

The Approach: Leveraging AI and Advanced Analytics in the Fight Against Fraud

Working together with VBA’s BDP&R team, we identified several improvements that would increase the efficiency of the agency’s fraud detection capabilities, shore up confidence in the program, and keep veterans’ benefits protected now and into the future. By improving the analytics driving VBA’s various fraud heuristics and applying advanced AI and machine learning techniques, we increased accuracy by reducing false positives, generated manageable reference lists, and helped focus investigation and remediation efforts on value-add activities to ameliorate fraud cases and proactively make veterans whole again without disrupting their lives. 

The Solution: Fully-Modernized Fraud Protection Systems for the Nation’s Veterans

Ä¢¹½ÊÓƵ Allen and VBA teamed up to develop analytical techniques tailored to the specifics of the various types of fraud that are most relevant to the agency.

For example, to help VBA improve its vigilance against suspicious IP addresses, we developed scripts to match and flag such IPs. We now monitor the resulting list for irregular activities. Additionally, to stop payments from being fraudulently claimed on behalf of deceased veterans, we built a new analytical tool that uses matching logic to identify improper payments with close to 100% accuracy. To help VBA filter out false positives from its suspicious-payment-redirect fraud investigations, we built a machine learning model to accurately identify instances of actual fraud.

These efforts combine to improve VBA’s confidence in the reliability of its fraud detection systems and increase the accuracy and efficiency of the BDP&R division’s work. By strengthening VBA’s ability to detect fraudulent activities with sophisticated analytics, we’re improving the integrity of the benefits process and advancing the agency’s overall mission of bettering the lives and circumstances of the nation’s veterans. 

Learn more about our Healthcare Transformation work