denotes premium content | Sep 7 2008 Feature
posted 1 Sep 1999 in Volume 3 Issue 1
Learning from loopholes
Fraud cannot thrive
in an environment of proactive knowledge sharing, where patterns of data reveal
and close off all potential backdoors to deception. In this article, Sue Colling
shows how effective knowledge sharing and consistent data collection continually
stamps out this unneeded visitor to the world of benefit claims.
'IT will help
government to become a learning organisation by improving our access to, and
organisation of, information... Information is duplicated and inconsistent. We ask
people repeatedly for the same details, creating opportunities for fraud and abuse.'
So stated the UK government in its 'Modernising Government' White Paper of March
1999.
This and
the previous government have both been conscious of the financial consequences
of fraud within the benefit claims area, which accounts for losses amounting to
several billion pounds per annum. Gathering the facts surrounding those claims
and ensuring that fraud was uncovered and punished was essential to ensure that
those genuinely in need of financial assistance could benefit. In support of
these objectives, the Department of Social Security (DSS) Benefits Agency began
to examine the possibility of applying data matching technologies to highlight
potential fraud. Such tools had already been used successfully in the Australian
Social Security department. Therefore, a senior manager seconded from Australia,
was assigned to work with the Benefits Agency team to assess how such technology
could be applied effectively in a UK context.
Having combined Australian experience
with the detailed understanding of its own systems, the Benefits Agency decided
that an external organisation should extend the current Generalised Matching
Service (GMS) system to meet scalability and flexibility requirements.
Therefore, in October 1994 the Benefits Agency in conjunction with the
Information Technology Services Agency (ITSA) asked several major companies to
tender for a system which would enable it to identify and prevent people from
claiming benefit under false pretenses. Syntegra, the systems integration
business of BT delivered this system in October 1995. It enabled the DSS to
apply its data, information and knowledge for the benefit of the nation's
finances.
Much time has been spent trying to differentiate between data, information
and knowledge, but the defining difference is context. While information is
often defined as 'data with a label', knowledge is 'information in context', or rather
'the capacity to act' as defined by Karl Erik Sveiby1. Knowledge Management can ensure that people
at all organisational levels are empowered and enabled to act more effectively
by receiving complete, correct and integrated information in the context of
their own skills and roles. The specific context in the case of the DSS was
fraud. Providing DSS fraud investigators with knowledge of who was committing
fraud and how they were doing it would give them the capacity to act upon that
knowledge, and ensure that fraudulent activities could be stopped.
Historically, the UK
government's focus was on detecting fraud after the event rather than preventing
it before it had time to take root. Clearly, as benefit fraud became
increasingly prevalent, the predecessors to the Modernising Government
initiative recognised the need to move from reactive detection to proactive
prevention.
Which tender?
In order to support this quest for
fraud prevention, the Department of Social Security put out to tender for a
system which would enable it to analyse the vast number of claimants records.
This would highlight possible discrepancies and potential fraud. Rather than
solely relying on the professional knowledge and experience of the Benefits
Agency staff, the DSS wanted to be able to transform data into real knowledge of
its customers and what they might be up to.
In the build up to the tender
response, two organisations competed for the delivery contract. One focused
heavily on the benefits that technology alone could bring, namely the speedy
analysis of reams of data in order to generate a multitude of cases for
investigation. The other organisation, Syntegra, realised the influence that
organisational issues would have on the success of the system. Investigative
sources are limited, so it was important that a system was developed which would
do more than simply generate a large amount of cases for investigation. Instead,
discussions with the future system users revealed the need for a flexible,
scalable system. Investigators needed not only to query cases using a consistent
set of criteria, but also to be able to apply lessons learned from past hunches.
As with all Knowledge Management systems, technology was just the enabler for
achieving as much as organisational constraints would allow.
By engaging with a
private sector company, the Benefits Agency aimed not only to share the risk and
responsibility of such an extensive implementation, but also sought to divest
itself of the provision of the underpinning technology solution. Thus, the
Benefits Agency GMS team was able to concentrate on the genuine, value-adding
activities of identifying potential fraud, which is its core competence.
Likewise, the extensive task of managing the systems which supported those
activities harnessed the core competence of its chosen service provider,
Syntegra. Both parties were therefore able to work together effectively,
applying their particular fields of knowledge and expertise to a shared problem
in order to achieve optimum results.
Discovering
patterns
Benefits Agency staff possess a high degree of professional knowledge.
They are now able to apply this to highlighting potential cases of fraud as a
result of having access to accurate, consistent and extensive data sources.
Staff can now record their wisdom and process all their gathered data
consistently. The Benefits Agency has turned its customer data into information
about 'claiming' patterns, which can then be turned into valuable knowledge
about customer behaviour and the risks of fraud being committed. It should be
noted that the GMS is fully compliant with the Data Protection Act, and the DSS
is always mindful of the rights of the individual in the fight against welfare
fraud.
Upon
securing the tender, Syntegra adopted a knowledge-sharing approach. By building
a close relationship with DSS users, the project team was able to ensure that
the right kinds of flexibility could be built into the system. This meant
flexibility not only in technical terms as to what additional functionality
could be allowed for, but also in terms of flexibility in the mindset of the
wider system community. In order to achieve this, Syntegra, ITSA and the
Benefits Agency had to work together to ensure that the technical system was
provided with timely data from the most useful sources. Encouraging system data
providers to consider fundamental changes in their business processes required a
strong understanding of the DSS organisation, its culture and powerful
negotiation skills. The change in mindset was disseminated throughout a number
of influencing groups, achieving prompt delivery of the data and the necessary
focus on the fulfilment of business-critical activities. The success of the
project also affected areas far removed from the user community. A spirit of
collaboration has been fostered in the government sector, as wider user groups
wish to benefit from the forward-thinking of the Department of Social
Security.
Exploiting hidden gaps
Consequently, further
opportunities have been identified for using the Generalised Matching Service to help
exploit the hidden knowledge of their systems and to support the experience
and expertise of their investigative employees for the customers' benefit.
An example of such flexibility and scalability is the adaptation of the
Syntegra system to provide a new understanding of who is entitled to receive
annual winter fuel payments. These benefits are calculated on a 'by household' basis,
which the previous multitude of systems had been unable to highlight. The
advantages that can result from having access to a central, consistent
repository of information and knowledge are considerable. The new system offered
an improved insight into the location of its customers, enabling them to benefit
from improved service and a warmer winter.
What the DSS project also served to
highlight was that technology is not always the answer. Having gathered the data
at the various sources, the decision was made to transport the data tapes to the
GMS headquarters by secure courier rather than sending data down the wires. As
the systems integration business of BT, transporting data via cable is
Syntegra's bread and butter, but in this case it was deemed immaterial for the
success of the project. The frequency and amounts of data transferred did not
warrant further technological consideration, but could be physically transported
just as easily and securely to Syntegra's GMS office.
Real teamwork
Following the close
working relationship that the Syntegra project team forged with the DSS user
community, it seemed a logical step to work together in deciding upon what new
analytical technologies to apply, rather than making an arbitrary choice. Given
the business-critical nature of these tools, it was logical that the Benefits
Agency staff themselves should choose the technology with which they felt most
at ease. By transferring their own product and technology knowledge, the
Syntegra project team worked with DSS users to help them evaluate the data
analysis tools which they would have to use on a daily basis.
Cultural
change
The cultural effects of the system have been felt over a wide radius,
within UK government and within society itself. Due to awareness of the
increased risk of getting caught, some potential fraudsters have been deterred.
Many people were making wrongful claims through misrepresentation of their
information, deliberately or by mistake; by highlighting previously hidden
loopholes in the entitlement criteria, the DSS could learn how to tighten up and
change the claims process. This is a true learning process, where the effective
application of knowledge harnesses powerful new ways of working.
The key
knowledge gleaned from this project is a much improved understanding of who
genuinely needs and deserves benefit. By filtering out the impostors and gaining
a cross-departmental view of its customers, the UK government will be able to
know whether any changes to the benefit entitlement criteria are needed to
ensure that the real customers are served justly. As the government's White
Paper confirmed: 'We have incompatible systems and services which are not integrated.
We must do more if we are to obtain the real benefits of information age
government, for better service delivery, better procurement and more efficient
working.'
By embracing the philosophies of true knowledge working, (becoming
a learning organisation and fostering best practice across departments), the
UK government is harnessing the benefits of effective knowledge management application.
Of all organisations and industry sectors, one may have thought that the
civil service and public sector might be the least likely candidate for
considering such far-reaching concepts. How wrong could you be! These
Knowledge Management initiatives, of which the DSS Generalised Matching Service was one of
the first, are all striving to achieve some key challenges for the UK government
into the new millennium. These challenges include: 'creating a more collaborative
and less risk-averse culture in the civil service... [and] improving
collaborative working across organisational boundaries.' The UK government has
not historically been renowned for adopting this approach, but now the
Chancellor's vision of a 'modern knowledge-based economy' seems increasingly to be an
achievable reality.
Sue Colling is Marketing in Syntegra. She can be contacted at:Susan.COLLING@syntegra.bt.co.uk
www.syntegra.com
| 1 The New Organisational Wealth , Karl Erik Sveiby, Berrett Koehler Publisher s, 1997 |
