LexisNexis Virtual SIU can streamline complex management processes and ensure that SIU activities are compliant with regulatory guidelines. The unit's proven data mining and case tracking methods save time and money by delivering case resolution results that matter.
- Reduce exposure to health care fraud and increase actual recoveries
- Maintain compliance with applicable regulations and requirements
- Help SIU staff identify and curb health care fraud activities
- Assist SIU by adding robust investigative resources that leverage proprietary data
LexisNexis® Virtual SIU™ can be deployed as a fully outsourced solution or used strategically to augment overburdened internal SIU efforts.
- Case Identification
- Development of Cases for Client Review
- Filtering of Providers and Cases
- Request and Review of Medical Records
- Pursuit of Recovery and Assistance in Appeals
- Periodic Reporting
- Provider Data Validation
Clients & Testimonials
The unit found a large number of potentially fraudulent activities quickly, LexisNexis began sending "great provider utilization reports." Among the findings were a number of potentially "egregious billers," and LexisNexis helped with the probe review of sample cases to validate the identified questionable claims,
Paul Peoples, SIU Compliance Officer Peoples.