fraud, waste, and abuse use case · fraud, waste, and abuse -government employees, contractors, and...

McLean,VA.

Fraud,Waste,andAbuseUseCase

CharlesBrownIBM-- cpbrown@us.ibm.comJohnStultzSAS-- john.stultz@sas.com

Manypeopleandorganizationscontributedtothisusecase.Inparticularwewouldliketothank:

• BillNiehausatNetOwl• JoeJubinskiatMITRE• RansomWinderatMITRE

Acknowledgements

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Fraud,Waste,andAbuse- Governmentemployees,contractors,andcitizensreceivereimbursementsfortravelfromfederalagencieseachyear.Wastherearequestedreimbursementforapatientcancelledappointment,orano-showappointment?

ThreatAssessment- Aftercomplexgeopoliticaleventsunfold,itmaybedifficulttogatherandvisualizeacompletepictureofthefullcontext.Didaterroristgrouphaveothersimultaneousactivity?

CyberForensics- Cyberattacksarenumerous,sudden,andrequireaspeedyreactiontime.Whoperpetratedtheattack?Whatistheextentofthedamage?

UseCases

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reservistsinconnectionwithaschemethatamountedto$870,000infraudulentexpenses

beingfiledbetweenAugust2007andSeptember2009

https://www.irs.gov/pub/foia/ig/ci/LAFO-2013-11.pdf

“Whileimproperpaymentsestimatesarenotameasureoffraud,alackofsufficientsupportingdocumentationmaymaskthetruecausesofimproperpayments—includingfraud.

Whenpaymentslacktheappropriatesupportingdocumentation,theirvaliditycannotbedetermined.Itispossiblethatthesepaymentswereforvalidpurposes,butitisalsopossiblethatthelackofdocumentationcouldconcealfraudulentactivities.”(GAO-17-631T,ReportandtestimonybeforetheCommitteeontheBudget,U.S.Senate,May2017)

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TravelVoucherProcess

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BeneficiaryLevel• paper/electronicclaimforreimbursementoftravel• travel/claimshistory(addressverification)• 3rd partyentityvalidation(SSN,name,address,phone)• travel/transportationreceipts

SourcesofDocumentation

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ClaimantLevel• ElectronicFundsTransfer• Entityvalidation(name,address,phone)

Services/OtherLevel• transportationservices• servicesofferedbynearbyfacilities,hoursofoperation• relationships(i.e.,subordinateapprovestravelvouchersforsuperior)

StoredinWebOntologyLanguage(OWL)Upper/MidLevelsuseSuggestedUpperMergedOntology(SUMO)DomainLevelisAEspecificSuperstructurecrossesusecases• Onlysubsetsoftheoverallontologyarerelevant(andnecessary)toeachusecase

Exampleentities(upper-levelontology)• Agent,Artifact,Identifier

Exampleentities(mid-levelontology)• Human,Organization,Building,Addresses,etc.

Exampledomainentities(domainontology)• ContentBearingObjectà Textà Voucher

AE’sOntologyDetails

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SUMO

SUMO

AESpecific

AnalysisTooltoAnalysisTool

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API

API

ExchangeFormat

FraudUseCaseOverview

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AnalyticsusingSASVisualStatistics:Exploreandpreparedata,interactivelycreateandrefinedescriptiveandpredictivemodels.

• Outlierdetectionusingpeergroupanalysisofexpenseestimatesgivensamegeographiclocationfortravelingfromandtosamefacilitiesofcare

• Peergroup“typeofcare”destinationfacilitylikelihood giventoandfromdistances,contrastedwithclosestfacilityofcare

• Probabilityestimatesofexpenseamountgivenclaimeddistances(i.e.,probabilityislowwhenmileageislowandmuchhigherwhenmileageimpliesanovernightstayortollbaseduponESRIrouting)

• Likelihoodestimatesoftreatmentfacilities• Weightedestimatesofriskgivenoneormoreindicatorsofriskfrom

ThomsonReutersdataenrichment.• Outlierdetectionusinganomalydetection

ScenariosforAnalysis

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AnalystNotebook:Initialview

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• TypicalLinkAnalysis“haystack”

• Highlightedtripsinpurplethatbypassednearertreatmentfacilities(basedonSASscore)

• Highlightedtripsinorangethathadunexpectedtolls(basedonSASscore)

• HighlightedindividualswithsuspectSSNSinbrown(basedonSASscore)

SuspectSSNs

AnalystNotebookFocusonIndividualswithSuspectSSN

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IndividualsallusingsameSSN,significantamountofsuspecttollsandbypassingnearerfacilities

ANBheatmapanalysisidentifiedadditionalsuspectSSNs(SSNlinkedtomorethanoneperson)….

AnalystNotebookExtendednetworkofsuspecttravelvouchers

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Samehomeaddresssharedby20individuals

JosephRobbappearstobeconnectionbetweenthisaddressandoriginalgroupofsuspectSSNs

Findusontheweb@www.Mitre.org/Roundtable

THANKYOU!