Department of Health and Human Services (HHS OIG)

"AI Ready" Data Architecture


The Department of Health and Human Services Office of the Inspector General’s (HHS OIG) mission is to protect the integrity of HHS programs as well as the health and welfare of program beneficiaries.

The HHS OIG's Chief Data Officer (OCDO) and Chief Information Officer (OCIO) work together to improve the access to and visibility of data.  They play an essential role in developing integrated, organizational-wide operations to better understand and prioritize investigations of waste, fraud, and abuse.

As the Federal Healthcare portfolio changes, healthcare systems become more complex and fraud cases become more sophisticated.  The detection of waste, fraud, and abuse requires a view of the “big picture” that is managed by different HHS OIG components across multiple geographic regions.

HHS OIG must ensure that all internal data sources are accessible and connected, the correct technologies are available for use, and the results can easily be shared with the right decision makers.

HHS OIG Offices of the Chief Data Officer and Chief Information Officer engaged Epigen

to provide leading-edge insight through the application and implementation of descriptive and predictive analytics, the development of AI Ready data architecture, and enterprise and solution architecture.

The implementation of data management, systems integration, and predictive analytics and visualization through the use of AI have helped investigators efficiently and effectively detect waste, fraud, and abuse and protect the integrity of HHS OIG programs operations to better understand and prioritize investigations of waste, fraud, and abuse.

The HHS OIG recognized that a strategic approach to managing data is a prerequisite to any business transformation or technology modernization effort.

Critical factors for success included:

  • Integrated Analytics: Enable HHS OIG to effectively validate and visualize their data to assist agents in optimizing leads to fight waste, fraud, and abuse.
  • Data Management: Enable HHS OIG to define and govern data across multiple stakeholders within HHS OIG offices for increased operational efficiency.
  • Evidence-based Decision-Making: Improve upon existing HHS OIG decision-making by leveraging new and unique data sources to further enhance data-driven decision making.
  • Data-Savvy Workforce: Enable HHS OIG to increase proficiency in modern technical approaches to assist in strategizing and prioritizing future business impact.

Epigen enabled the HHS OIG to achieve these four critical success factors by:

  • Providing insight and leveraging visualizations and statistical models, which allowed HHS OIG to prioritize cases of fraud and align internal resources for further investigation.
  • Connecting business processes through integrating and managing data sources and ensuring information is available to those who require access.
  • Clearly defining and identifying metadata standards to assist HHS OIG in governing existing and future datasets.
  • Integrating information from multiple HHS OIG systems and analyzing relationships, between a data use agreement and impacted data sets.
  • Incorporating data traceability to better understand the quality of the data and use of the data in the overall decision-making process.
  • Enabling datasets to be searchable, with read-access, across all HHS OIG components.
  • Integrating external data sources to facilitate the research of unexplored relationships and insights which build upon existing models and analysis.
  • Providing guidance and training to HHS OIG staff on best practices relating to technology solutions and agile methodologies.