VIS/SGI SOLUTION HELPS HCFA FIGHT MEDICARE FRAUD AND ABUSE

SGI announced that Veridian Information Solutions (VIS) has helped the federal Health Care Financing Administration (HCFA) develop a comprehensive solution for detecting and investigating fraud, waste and abuse in the Medicare claims system based on SGI data mining technology.

With the help of SGI, VIS has designed and implemented a data analysis environment for HCFA that is capable of detecting meaningful correlations, patterns and trends by sifting through information extracted from a variety of Medicare databases. SGI MineSet, a suite of software tools for data mining and data visualization, is the cornerstone of this integrated solution for identifying suspicious Medicare billing and treatment practices.

SGI MineSet is an advanced scalable client/server tool set for extracting information from data warehouses, mining the data with sophisticated analytical algorithms, and revealing newly discovered patterns and connections through intuitive, interactive, visual displays. Combined with the high-performance SGI Origin 2000* server, MineSet has provided HCFA with a unique solution for extracting valuable information from its data resources. Using just four months of Medicare Part B claims data, the MineSet application identified cases with potential overpayments totaling nearly $2 million.

"The SGI hardware platform and software suite were selected carefully for this project based on their proven track records for supporting databases of the size required to manipulate HCFA's yearly 800 million-plus claims records and supporting information," said Kirk G. Johnson, project manager, VIS. "The SGI Origin family platform offers that amount of processing power and, nearly as important, the scalability to address future data and processing needs."

An SGI Origin 2000 server with eight CPUs, 8GB of memory and 1.7TB of data was designed to efficiently handle the requirements of the Oracle8I DBMS and the analytical tools to be applied to that database, including MineSet. "From a hardware perspective, having sufficient processing power to handle two large applications, a large database and a number of users applying statistical and data mining techniques was critical," said Johnson.

The SGI Origin server family is used for high-performance, computationally intensive applications in business, government and the scientific and technical communities. Use of SGI MIPS processors, combined with its IRIX operating system and NUMA architecture in a 64-bit scalable server environment, allows the SGI Origin family to scale to thousands of processors, providing the opportunity to seamlessly grow as customer requirements demand.

"From a software perspective, the superior ability MineSet offers for visualizing very large data sets was tremendously important. Nearly as important was the efficiency with which MineSet manipulates those same large data sets," said Johnson. "We have corporate experience with a number of other tools, including Enterprise Miner, Angoss KnowledgeSuite/KnowledgeStudio, the Cognos toolset and others, but we feel MineSet offers better performance and visualization techniques when managing and manipulating very large data sets such as the 800 million-record HCFA data set."

The major effort in any data mining project goes into preparing the data and building tables. VIS opted to create two such tables: one summarized the billing and treatment behavior of each Medicare provider, while the other captured the nature of services provided to each Medicare recipient or beneficiary.

"The MineSet tool allowed our analysts to quickly scan these summary tables, sorting, binning and aggregating columns on the fly. This greatly simplified the detection of questionable billing or treatment practices," said Robert Garcia, lead analyst, VIS. "The MineSet suite of 3D visualization tools provided the analysts with a means to quickly identify outlays of interest. The tables used in the data mining process are, of course, unique to the current application. But the process used can be applied to any fraud detection or indeed any data mining task."

By combining data access, transformation, analytic data mining and visualization, MineSet creates a unique environment for exploring data elements and achieving a more thorough understanding of an organization's operations. With the wisdom and insight gained from MineSet, an agency or organization is positioned to make better decisions and operate more efficiently.

About VIS

VIS, based in Arlington, Va., specializes in high-performance computing and software development; large-scale data analysis and data mining; data warehouse solutions; analytical visualization tool solutions; and mission-critical operational support. VIS is a privately held $650 million integrated solutions provider whose core business areas include securing data, network and communications infrastructures and applying knowledge-management tools for effective decision-making.

About SGI

SGI provides a broad range of high-performance computing and advanced graphics solutions that enable customers to understand and conquer their toughest computing problems. Headquartered in Mountain View, Calif., with offices worldwide, the company is located on the Web at www.sgi.com.

• Origin 2000 is now being marketed and sold as the SGI 2000 series.

Contact Gregory Slabodkin, SGI Federal, 301-595-2618, slabodkin@sgi.com or Kirk Johnson, VIS, 703-383-1650, kirk.johnson@veridian.com.