Fraud Management: The Case for Multibusiness Models

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Any organization can be victimized by fraud. Consider the case of a Toronto-based orthotics store that recently defrauded insurance provider Manulife out of more than four million dollars using fake Toronto Transit Commission (TTC) insurance claims. Contrast this with the $127.4 billion in fraud U.S. federal organizations face each year from “improper payments” — a big enough problem that the Government Accountability Office (GAO) has developed a new framework to help agencies minimize this risk.

Just as fraud can vary in scope and size, however, case management takes markedly different forms across business models, often hampering the progress of investigations as they move from one organization to another — what if it were possible to leverage a set of universal case management solutions and take aim at fraud sources rather than symptoms?

Fraudulent Frustrations

All frauds come with three component parts: Malicious actor, victim and stolen value. In some cases this value is money, in others identity, brand reputation or insurance benefits are at risk. In Toronto, a group of three malicious actors created a string of false insurance receipts, while in the United States millions of fraudsters have managed to claim un-owed payouts.

Once these frauds are identified, however, the need to manage large data sets, handle evidence and comply with local records-keeping requirements significantly changes investigation methods and outcomes — resulting in case files which are difficult if not impossible to share with relevant agencies. For example, if Toronto police had information suggesting a similar fraud took place in another city, swapping case data throughout municipal lines quickly becomes problematic.

Inclusive Investigations

The good news? Managing widespread investigations for multiple business models is possible with the right fraud management software. By leveraging a solution that automatically handles all intake documentation, journaling and evidence management, and can effectively associate disparate data using advanced visualization techniques, it's possible to create a logically segmented case that meets all compliance standards and can be effectively shared across organizational boundaries.

Of course, documenting frauds and solving cases don't always go hand in hand. Fraud investigation software must address this issue by providing a means to organize and prioritize the most “solvable” cases first, allowing agencies to focus their efforts on high-solvability cases with the greatest organizational impact or public recognition.

As fraud efforts diversify and malicious actors take aim at everything from insurance benefits to government payments, companies need improved case management software that not only automates critical processes but helps manage investigations across multiple business models.

Last modified on Tuesday, 18 August 2015

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