Background.

In 2009, Truven Health (later IBM Watson) won a large contract with a state Medicaid customer. I was housed with the client on-site for a variety of products. This particular one was outside of Truven’s typical offerings. They did not yet have a set of standard practices to draw upon in order to build so asked that I sit with clients and learn about the “work of fraud analysis.”
As a consultant with Truven/IBM, I was asked to observe the current work practices of state Medicaid Fraud Analysts in order to build a new, user-centered system.

Method.

I interviewed all fraud analysts and their manager in a focus interview style manner to map out workflow at a high-level [I would do this differently now). This provided me with a starting place to understand what I’d be seeing during 1:1’s.

I then sat with three fraud analysts for two days and watched as they interacted with their current system and with each other, taking notes and asking questions.

I learned that so much of their work was outside of any traceable system, yet required information be tracked. They’d also created secondary methods to capture important data (Word, Excel).

Impact.

Truven/IBM went to work with a subcontractor to develop software which would be as comprehensive as possible. Only so many modules could be added, drop-downs added, pathways altered, however. While it was nearly impossible to cover all of this team’s needs with one piece of software, it was a vast improvement from where they started.