Using Dynamics GP to report on insurance fraud

Posted by Eric Suggs

The FBI is the primary investigative agency with jurisdiction over both federal and private insurance programs.​

With total healthcare expenditures in the U.S. expected to reach $2.26 trillion by 2016, the opportunity for fraud will continue to grow. That means we have to find ways to leverage our resources.

A need for better reporting

Companies involved in the healthcare industry are required to identify and report employees the FBI has previously identified as having committed insurance fraud or risk losing federal funding.

Unfortunately, the mechanism to find these employees is fairly cumbersome. Someone must manually compare the personal information provided by their company’s employees with similar information on a website maintained by the U.S. Department of Health & Human Services, and they may only do so five employees at a time.
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Fortunately, the customization capabilities of Dynamics GP allowed the development team at InterDyn Artis to create a utility to greatly increase the speed of this process.

How does the utility work?

The user downloads the entire fraud database from the website, runs a SQL Reporting Services report to automate identifying likely matches and then saves those records to an Excel file with a click of a button.  The process from beginning to end takes about five minutes instead of several hours.

​In addition, the report shows the strength of the match between the company’s employee information and the fraud database.

• The most likely case of insurance fraud is if the employee last name, first name and date of birth match the data downloaded from the website
• The second most likely scenario the employee has committed fraud is that the last name and date of birth match the date from the website
• Finally, if the employee’s last name and first name match, it is possible they committed insurance fraud