FraudFocus®

Detect possible fraud at the earliest possible moment

FraudFocus® is an effective fraud detection system that helps insurance companies proactively combat several types of fraud.

Benefits
  • Identify the likelihood of fraud at the earliest possible moment.
  • Identifies claims that have a high probability of being fraudulent.
  • Identifies medical providers with suspicious billing activity or unusual treatment patterns.
  • Identifies policies with discrepancies or irregular combinations.
  • FraudFocus automates and standardizes the fraud detection process, providing a new level of consistency and efficiency when searching for potential fraud.

Get it now: For more information about LexisNexis® FraudFocus®, call 800.869.0751.

Features
  • FraudFocus compares each claim, provider or policy to historical fraudulent patterns identifying the likelihood of fraud at the earliest possible moment.
  • Reviews each claim, provider or policy for subtle fraudulent patterns using techniques more powerful than traditional red flags or rules alone.
  • Reviews each claim and provides alerts when thresholds have been exceeded.
  • Compares individuals and organizations to internal and third-party lists to flag matches of similar identities.
  • Allows an investigator to search for links among claims’ data elements that may point to collusion or rings.
  • Prioritizes and organizes claims so the most appropriate action can be taken through automated special investigative unit referrals, additional data look-ups and adjuster or specialist notification.
  • Provides reporting, tracking and analysis tools to identify trends and optimize the fraud referral and mitigation process.

FraudFocus uses the following technology:

  • Predictive Model Scoring
  • Business Rules
  • Identity Matching Manager
  • Link Analysis and Visualization, powered by i2
  • Reporting Engine

Get it now: For more information about LexisNexis® FraudFocus®, call 800.869.0751.

Contact Us

For more information about our solutions call 800.869.0751. or contact us online

FraudFocus does not constitute a "consumer report" as that term is defined in the federal Fair Credit Reporting Act, 15 USC 1681 et seq. (FCRA). Accordingly, FraudFocus may not be used in whole or in part as a factor in determining eligibility for credit, insurance, employment or another permissible purpose under the FCRA. FraudFocus is a registered trademark of ChoicePoint Services Inc.

Due to the nature of the origin of public record information, the public records and commercially available data sources used in reports may contain errors. Source data is sometimes reported or entered inaccurately, processed poorly or incorrectly, and is generally not free from defect. This product or service aggregates and reports data, as provided by the public records and commercially available data sources, and is not the source of the data, nor is it a comprehensive compilation of the data. Before relying on any data, it should be independently verified.

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