Interactive and Iterative Behavioral Model, System, and Method for Detecting Fraud, Waste, and Abuse

摘要

An interactive, iterative, and/or reiterating behavioral model (FWA-IIRB) for detecting, preventing, and/or mitigating fraud, waste, and abuse in an industry is provided. The model is comprehensive and facilitates analysis of different types of fraud cases in different ways. For example, an approach may be determined by the nature of the industry. Likewise, the identity of a primary player identified by the system may at least in part determine the approach. The WA-IIRB model is comprehensive in data collection and effective in handling a wide variety of situations, players and industries. Simultaneously, the system builds data volume by creating additional data points and discovering gaps as the model/framework proceeds to final output/results. By tailoring the analysis algorithm to the type and content of the data provided to the system, the invention improves a computer's speed and efficiency in processing the data and supplying a result.

主权项

1. A system for identifying fraud, waste, and abuse in an industry, comprising:
a plurality of industry computer devices deployed in the industry; and a server communicatively linked to the plurality of industry computer devices, the server configured to receive data inputs pertaining to a case from each of the plurality of computer devices and programmed to sort the data inputs into one or more applicable behavioral continuum components of a framework comprising a plurality of behavioral continuum components, each behavioral continuum component communicatively linked to each of a plurality of databases, each behavioral continuum component being programmed to further sort the data inputs pertaining to the respective behavioral component into one or more of the plurality of databases, the server being programmed to tie data from the plurality of databases back to the behavioral continuum components, to aggregate the data into a pooled database of the case, to identify an abnormal data point or a discoverable gap in the pooled database, and to alert a user of one or more of the industry computer devices to the abnormal data point or discoverable gap.