Fraud detection and control is a critical focus area for all social service organisations globally, especially during times of financial crisis. Therefore, most National Government social security and health insurance agencies are driving programmes to reinforce their audit capabilities, improve compliance, increase revenue collection and control disbursements.
Integrated technology plays a vital role in influencing the success of proactive and preventive fraud control mechanisms to enhance effectiveness and optimise results.
One of the first organisations to benefit from this is the largest Social Security Organization in Greece “IKA” who implemented ESKORT as part of an integrated Social Security application suite delivered by INTRASOFT International. Using the system capabilities, the organisation successfully exposed many cases of fraud.
The innovative auditing mechanism of ESKORT utilises risk analysis methodologies, based on quantitative (e.g. sick days) and qualitative data (e.g. insurance data) extracted from the organisation’s data warehouse. By identifying and providing on-line alerts for possible violations, preventative audits can be carried out before a decision to provide benefits to insured citizens is reached.
The risk analysis control mechanisms are applied to employer contribution declarations in order to prevent and identify potential contribution fraud, and the solution provides auditing and proactive control processes incorporated by the social security organisation.
The Intrasoft Compliance Suite (also known as ESKORT), already well-established and providing support for compliance processes within tax and/or customs authorities, was expanded to provide risk, compliance and enforcement support for social and health insurance agencies such as IKA.
The results of the new system were impressive: in the first few months of operation the system revealed benefit fraud associated with totally blind people and pinpointed cases of contribution evasion worth several million euros.