fraud, waste, and abuse use case · fraud, waste, and abuse -government employees, contractors, and...
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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
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“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)
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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
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AnalysisTooltoAnalysisTool
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API
API
ExchangeFormat
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FraudUseCaseOverview
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AnalyticsusingSASVisualStatistics:Exploreandpreparedata,interactivelycreateandrefinedescriptiveandpredictivemodels.
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• 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
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AnalystNotebookFocusonIndividualswithSuspectSSN
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IndividualsallusingsameSSN,significantamountofsuspecttollsandbypassingnearerfacilities
ANBheatmapanalysisidentifiedadditionalsuspectSSNs(SSNlinkedtomorethanoneperson)….
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AnalystNotebookExtendednetworkofsuspecttravelvouchers
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Samehomeaddresssharedby20individuals
JosephRobbappearstobeconnectionbetweenthisaddressandoriginalgroupofsuspectSSNs