Using an Integration Platform to Help Prevent Waste, Fraud, And Abuse In Government Agencies

Today, more than ever, government agencies need to ensure that money is spent wisely and correctly. In this article, you’ll learn how Software AG’s webMethods Integration Platform assists agencies with waste, fraud, and abuse.

Using unemployment claims processing as an example, I’ll describe how existing processes can be quickly and easily adapted to save money and meet ever-changing business demands.

Currently, there are several problems state agencies face when administering employment benefits. For example, people who are ineligible are getting unemployment payments due to a lack of centralized verification of their status. Meanwhile, investigators are overwhelmed and their departments are short-staffed.

In many cases, when a citizen applies for these benefits, their request often goes directly to a legacy system application, where existing rules are used to review the application and payments are processed.

Unfortunately, rules around unemployment claims are changing frequently of late. The challenges we hear about are overpayments or even denial of payments based on limits that are no longer applicable.

Due to a lack of programming resources and staff, and an increased volume of transactions created by the pandemic, agencies are hard-pressed to keep up with upgrades necessary to route and process these queries appropriately.

And that’s where the challenge is. Existing rules residing in the legacy system are inflexible, take time to change, and sometimes overwhelm the system. Agencies may also lack programmers and staff capable of updating these legacy systems efficiently.

Now, let’s look at how an integration platform can add to that process. By adding an integrated platform as an eligibility clearing hub, agency IT leaders can do much more to avoid delivering benefits to ineligible parties. Using a central eligibility clearing hub, states can access multiple databases which help staff screen applicants more thoroughly.

In this example, an eligibility clearing hub might connect to a wide range of data sources relevant to eligibility, including state corrections systems, cloud-based pension database, and 3rd party verification services such as ID.me to avoid identity theft.

The reason our integration platform can connect so quickly and easily to such a wide variety of data source is our wizard-driven adapters – they allow users to make connections without being experts in the connected technology. This can be done using existing technology assets.

One of the problems our platform can help address is overpayments or denial of payments that are taking place due to limits that are no longer applicable. Changes to these limits can take time and put stress on already limited resources. By adding a business rules engine available in webMethods, changes can often be done by business staff, rather than technical experts.

For example, consider how this kind of data integration has benefitted the state of Pennsylvania. Two state agencies there have saved more than $200 million. More than 50,000 people were filing for unemployment from jail, which is not allowed.

With all that being said, unemployment claims are just one example of how our integration platform can simplify the process of screening citizens applying for benefits. webMethods can help with a variety of areas of government spending to ensure that those dollars are going to qualified recipients.

In the case of Medicare and Medicaid, agencies can use the federal eligibility hub to screen applicants’ determining eligibility for SNAP, TANF and CHIP benefits, as well as preventing overpayment and Worker’s Comp fraud & abuse detection, which staff can use to determine eligibility and run smart fraud case management programs.

If you want to hear more about how webMethods can help your meet your data integration needs, view the entire on-demand recording here.