Fraud. It's easy enough to imagine. It happens every day, to someone. Right?

Wrong. It happens every day to you and to others just like you. Benefits fraud isn't just fraud against the system. At the end of the day, it affects all taxpayers and legitimate recipients.

Today most state offices dealing with benefits fraud handle thousands of calls and paper complaints claiming illegal activity. The tracking systems in place are primarily for reporting purposes only, not for handling such heavy loads of data. Many cases move from county to county, and coupled with basic record maintenance and reporting requirements, the files continue to grow. If an investigator requires additional documentation while in the field, a trip to the office is a must. When processing paperwork, it's a phone call, a transmittal request or both; and every case is then processed through the postal service. Each of these steps causes significant delays and extends processing time.

In Georgia, the Office of Investigative Services (OIS) within the Department of Human Resources (DHR) -- the entity responsible for tracking benefits fraud in the state -- is streamlining the way it tracks and deals with benefits fraud. The OIS is implementing a flexible Web-based investigation solution that streamlines the entire investigative and remediation process. This comprehensive system flags and processes what may turn out to be fraud, abuse or waste.

Where There's a Will, There's a Way

The OIS is responsible for establishing more than $6 million in inquiries each year, and turns over more than 4,000 cases per year. To manage this increasingly complex problem, the OIS began looking for a system that would help streamline the investigative process.

Their search led them to HCL Technologies and a solution that could address not only their present departmental challenges, but scalable enough to anticipate future needs as well.

The Investigation Services Information System (ISIS), which is in its final stages of implementation, is capable of automatically matching suspects from the database and case linking each one. The system can calculate claims for various assistance programs while generating real-time status reports and performance statistics. It can alert the user to a pending deadline, verify the effective appropriation of resources and dynamically create the required paperwork and letters for each case. ISIS even load-balances casework while data-mining each transaction, creating a central repository for individuals to access at any given stage. Before, case files required archiving and then red tape to find them again. With this new system, OIS is paperless.

"ISIS has enabled us to integrate multiple business processes. It has an automatic interface with SUCCESS, the statewide mainframe computer system that houses all the data on active and closed public assistance cases in Georgia," said Judy Bullard, assistant director of the OIS. "Prior to ISIS, investigators had to manually access the SUCCESS system and manually print each case. Not only does this save a lot of time, but we have saved millions of trees."

Today's ISIS is just the beginning -- but a big beginning it is. For example, take the DHR's biggest client: the DHR's division of Family and Children Services. Before ISIS, investigators had to complete case referrals via paper. Today they can complete the referral process online. ISIS automatically tracks the 12-month federal time limit on a case, versus manually entering it into a log. And the system allows for interagency communication, significantly reducing bottlenecks in response time.

The Future Is Now

Eventually ISIS will have an Electronic Benefit Transfer (EBT) Trafficking Module. Presently welfare clients receive their monthly benefits through an EBT card each month -- similar to a debit card.

"The new wave of fraud is for a client to sell their card to a vendor or sell a portion of their benefits for cash -- usually 50 cents on the dollar," said Bullard. "The Feds are focusing on this type of abuse. We have been addressing trafficking for two years."

It used to take at least two people and three weeks to identify and start investigating cases involving trafficking, said Bullard. Staff manually entered EBT data on stores and clients into a spreadsheet. Once cases were identified, case information had to be physically entered into a separate system and paper copies were sent to investigators. ISIS will identify vendors suspected of trafficking, flag potentially fraudulent transactions and generate cases automatically, cutting the process down to only two days.

"Our process time has been cut dramatically. The time spent on generating paperwork has been reduced by 50 percent," said Bullard. "We couldn't ask for a better outcome."

Kristen P. Wilson  |  Contributing Writer