NCDIT Data Division Creates Tool to Assist OSHR Investigators with Fraud Detection

A new visual analytics tool is helping investigators at the N.C. Office of State Human Resources detect potential fraud and improper payments made to state workers for workers’ compensation claims. OSHR collaborated with the N.C. Government Data Analytics Center, within the N.C. Department of Information Technology, to create a reporting dashboard that went live in late October.

The dashboard compares claimants’ information to other state and federal databases, such as the Social Security Administration’s death master, the unemployment office’s wage and benefits report and incarceration information in CJLEADS, a criminal justice database also developed by GDAC. Information can also be queried through NC eLink, a data integration tool developed by GDAC to link together disparate administrative systems for state and federal agencies.

The dashboard populates alerts that indicate potential areas of fraud, waste, abuse or improper payments to focus investigative resources more efficiently. OSHR investigative staff will research reported matches to determine if any action should be taken regarding an individual claim. Only certain staff members who conduct these investigations have access to this information.

It is important to note that an alert does not indicate that improper payments are occurring or that a state employee is guilty of any wrongdoing. The dashboard matches employees to their benefit period and provides leads to OSHR investigators to follow up and verify whether a state employee is receiving appropriate benefits.

The dashboard is already helping OSHR employees focus their investigative efforts by giving them a more detailed view of claimants at their fingertips. Using the reporting dashboard, investigators can see if someone is deceased or incarcerated, what their wages are and what benefits they are receiving.

For instance, by matching records to the Social Security Administration’s death master database, investigators can see if an employee who was receiving benefits is now deceased and payments should cease. It can also indicate what level of benefits an employee who has been injured or is on disability should receive if they are able to return to light duties. OSHR will be provided with match results for information found in any of the databases listed above on or after the employee’s date of injury. This substantially raises awareness of instances where state employees may have been receiving workers’ compensation benefits to which they are not entitled.

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