Audit Policies Under the Sentinel Effect: Deterrence-Driven Algorithms

• 成果类型: Article
• 署名作者: Bouayad, Lina; Padmanabhan, Balaji; Chari, Kaushal
• 署名单位: State University System of Florida; Florida International University; State University System of Florida; University of South Florida; University of Wisconsin System; University of Wisconsin Milwaukee
• 刊物名称: INFORMATION SYSTEMS RESEARCH
• ISSN/ISSBN: 1047-7047
• DOI: 10.1287/isre.2019.0841
• 发表日期: 2019
• 页码: 466-485
• 关键词: social contagion; INNOVATION; diffusion; network; FRAUD

摘要

Fraud, waste, and abuse are significant problems in major industries such as healthcare, particularly when third-party payers such as Medicare are involved. Auditors looking for fraudulent activities use scoring models to select practitioners or claims that are likely to be fraudulent. In addition to the direct benefits of the audit effect, which evokes a response by auditing fraudulent individuals, the sentinel effect provides second-order benefits. Yet current auditing algorithms do not take the sentinel effect into account. In this paper, we present an algorithm that supports a deterrence-driven audit approach in the presence of audit and sentinel effects. Our results indicate that a significant reduction in healthcare excess costs can be achieved, while maintaining fairness, when auditing policies take sentinel effects into account.