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Program Integrity for Government & Public Services

Driving program efficiency and effectiveness through improved payment management

Today, government agencies that provide public benefits are looking for ways to drive greater impact in the services they provide. Health care, unemployment compensation, SNAP benefits, student loans, school breakfasts, veterans’ benefits, and other programs rely on federal and state funding that is then distributed to eligible individuals based on established criteria. Ensuring that payments are managed properly and getting the right payment in a timely manner to the right individuals is critical for agencies to achieve their objectives. Deloitte can work with you to design and help improve distribution strategies to support greater program impact.

Watch the video to learn about Deloitte’s new approach to program integrity

The cost of improper payments

Improper payments generally are the result of three major causes: Program process redundancy, error, or fraud/abuse. While process redundancies may be built into programs intentionally or accidentally, many agencies can improve their overall program effectiveness, preventing improper payments. An audit of the funds lifecycle from federal distribution to final disbursement can identify where possible “leakage” may occur and what areas have the highest potential for human errors. Fraudulent activities may range from singular individuals misrepresenting information to sophisticated networks of benefit theft. In addition, today’s digital networks and web-based transaction systems have opened doors to new fraud risks.


Strategies to help improve program integrity

How can government agencies address the problem of improper payments and drive greater program impact? One word: Prevention. Agencies can improve efficiency and customer service, while reducing costly errors, by focusing on prevention activities, instead of trying to recover improper payments after the fact. Deloitte can help agencies move from recovery to prevention by viewing program integrity through an enterprise-wide lens. Addressing the root causes of problems prior to payment helps move agencies away from the “pay-and-chase” cycle. This type of proactive approach—one that leverages risk management, predictive analytics, behavioral insights, and collective intelligence—can help agencies reduce fraud, waste, and abuse while improving overall program effectiveness.


Advanced services

Deloitte can work with your government organizations to proactively address improper payments through advanced services.

Perspectives: AI for Medical Record Review: AI-driven, User-Centric Medical Record Insights

Medical Record Review (MRR) is a complex, time-consuming process requiring a specialized skillset to identify whether a claim has been paid correctly, aligns with payment policy, and is compliant with regulations.  Artificial Intelligence (AI) is starting to be used in MRR to aid the process by expediting review cycles with AI-driven models that accelerate processing while adhering to policy and sub-regulatory guidelines.  How can the use of AI enhance the efficiency of performing MRRs?

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Read the report: AI for Medical Record Review

Perspectives: Infusing Equity into Program Integrity: Why is Health Equity a Program Integrity Issue?

Achieving health equity, wherein each individual has timely access to high-quality services that allow them to achieve the best health they can regardless of their personal characteristics, is a core goal of health care agencies.  Incorporating a health equity lens can improve organization effectiveness in preventing, identifying, and investigating fraud, waste, and abuse.  How can a health equity lens be integrated into program integrity?

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Read the report: Infusing Equity into Program Integrity

Perspectives: Aggregated Risk: How to find fraud in complex healthcare systems with risk triangulation

The oversight of State Medicaid programs includes the challenge to evolve with the ever-changing fraud, waste, and abuse (FWA) landscape. New policies, legislative mandates, and waiver exceptions in the midst of the Public Health Emergency have compounded the host of potential FWA that can occur within the Medicaid program.  How can the use of risk triangulation assist in identifying additional FWA?

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Read the report: Aggregated Risk

Perspectives: Meeting the challenges to program integrity: A model for success

As in any period of crisis and uncertainty, the need for trust and resiliency in government has intensified. Individuals, families, businesses, as well as health care, educational, financial, and other institutions all look to—and depend upon—government to provide guidance, support, and coordination of response efforts. While this is true of government at all levels, it is particularly true of federal government agencies. So how can federal agencies achieve and maintain program integrity?

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Read the report: Meeting the challenges to program integrity

Perspectives: Analytics and Human Insight: A powerful combination

The federal government, working in collaboration with states, spends billions of dollars a year to fund vital social services and benefits. How can content-deep forensics help to ensure that social services dollars are spent more appropriately and that benefits reach individuals and families who qualify for them?

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Read the report: Analytics and Human Insight

Perspectives: Improper payment reduction and prevention strategies

Government agencies can increase payment accuracy in public programs by understanding the root causes of improper payments and adopting strategies to increase payment accuracy. Read our perspective, The buck stops here, written in collaboration with The Partnership for Public Service, for more information.

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Why Deloitte?

Deloitte has an unparalleled history of defining innovative strategies and implementing leading practices across government entities and addressing the demands of myriad stakeholders throughout all branches of federal, state, and local government. Our industry experience provides us with unique end-to-end payment lifecycle insights from program funding, to processing and management, and payment. We bring a variety of financial management, strategic and organizational planning, analytics, and business process improvement capabilities to meet the needs of your organization.

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Get in touch

Lauren A. Allen

Lauren A. Allen

Managing Director| Risk & Financial Advisory

Lauren is a managing director in Deloitte Transactions and Business Analytics LLP and leads the Government & Public Services Program Integrity practice. She specializes in working with organizations t... More