Försäkringskassan. (Swedish Social Security Agency) Computer Analyses to Identify Frauds 2013 Page 1

Transcription

1 Försäkringskassan (Swedish Social Security Agency) Computer Analyses to Identify Frauds 2013 Page 1

2 Håkan Hagberg Internal investigations Computer analyses Identify frauds against Försäkringskassan Computer Analyses to Identify Frauds 2013 Page 2

3 Agenda Short summary of the Swedish Social Insurance Agency Why computer analysis? (Hint fraud of 3 million) Computer analysis and internal investigations Example of analysis and fraud detection Benefits with Computer Analysis Q & A Computer Analyses to Identify Frauds 2013 Page 3

4 Short summary of the Swedish Social Insurance Agency Government Structure Parliament and government Legislates (laws and ordinances) Government agency Service to the public Computer Analyses to Identify Frauds 2013 Page 4

5 Försäkringskassan - Social Insurance Agency 54 million payments per year (including pensions) totalling approx. 40 billion 300 offices Around 12,800 employees Computer Analyses to Identify Frauds 2013 Page 5

6 Organisation Public Commissioner Advisory Board Local Insurance Centres Director-General Internal Auditing Office Security staff Insurance Processes National Insurance Centres Analysis and Forecasts Customer Centre/ Self service IT Legal Department Operational Support Computer Analyses to Identify Frauds 2013 Page 6

7 Security and environmental staff Director of Security and 13 co-workers at three locations Computer Analyses to Identify Frauds 2013 Page 7

8 Computer analysis and internal investigations Computer Analyses to Identify Frauds 2013 Page 8

9 Why computer analysis? Computer Analyses to Identify Frauds 2013 Page 9

10 Computer Analyses to Identify Frauds 2013 Page 10 Fraud tendency

11 Computer analysis at Försäkringskassan Staff comprises 7 people, 4 analysts and 3 investigators. Computer Analyses to Identify Frauds 2013 Page 11

12 Activities to strengthen Försäkringskassan credibility Systematic control of Payments to insured Users transaction in systems And Inform employees of the consequences if rules are violated Computer Analyses to Identify Frauds 2013 Page 12

13 External Clients of computer analysis The pension authority Internal HR department Local security Finance staff Administration of access rights Computer Analyses to Identify Frauds 2013 Page 13

14 Two different types of computer analysis Targeted computer analysis Investigative computer analysis Computer Analyses to Identify Frauds 2013 Page 14

15 Computer analysis work method 1. Identifying risks in operation 2. Developing computer analysis scripts 4. Dealing with the result 3. Undertaking the analysis Computer Analyses to Identify Frauds 2013 Page 15

16 Process of internal investigations 1. Initial actions 2. Start investigation 3. Collect information 4. Analyse and conclude 5. Decision of further handling 6. Ending actions Computer Analyses to Identify Frauds 2013 Page 16

17 System logs Payments info Insurance info Info from case handler Tip from the public Access logs Information to use Computer Analyses to Identify Frauds 2013 Page 17

18 On going Investigative analyses Computer Analyses to Identify Frauds 2013 Page 18

19 Computer Analyses to Identify Frauds 2013 Page 19 An actual case

20 What is attendance allowance? Computer Analyses to Identify Frauds 2013 Page 20

21 Number in sickness relive Example of an Operation -Attendance allowance Number in attendance allowance Year 0 Computer Analyses to Identify Frauds 2013 Page 21

22 Example of an Operation -Attendance allowance Identify and report suspect payments within the attendance allowance locally 1. Finding indicators 2. Analysis and scripting 4. Improve indicators and suggest solutions 3. Analyse script results Computer Analyses to Identify Frauds 2013 Page 22

23 Example of an Operation -Attendance allowance Findings Large amounts Money leaving Sweden Feeding criminal organisations Computer Analyses to Identify Frauds 2013 Page 23

24 Result of the Case m in suspect frauds 30 full time investigators, prosecutors, tax specialists and police 25 company is investigated, more to come 500 suspect so far Court negotiations a mass during 2013 Excepted convictions on all suspects! Computer Analyses to Identify Frauds 2013 Page 24

25 Computer Analyses to Identify Frauds 2013 Page 25 Summary

26 Dealing with the findings Suggestions for legislators. Suggestions to change some parts of the case handling Investigation and police reports to stop the ongoing frauds Spill-over information that can be used to do other types of computer analysis Identified efficiency potential. Greater confidence in the agency from citizens, the government and inspection agencies. Computer Analyses to Identify Frauds 2013 Page 26

27 Computer Analyses to Identify Frauds 2013 Page 27 Questions?