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LexisNexis Addresses Next Wave of Health Care Fraud Prevention by Using Predictive and Social Network Analytics

November 2, 2011 — LexisNexis Health Care Executives to Present Next Week at National Predictive Modeling Summit

ATLANTA – Today, LexisNexis Risk Solutions announced that Bill Fox, senior director of health care and Clint Fuhrman, senior director of government health care will speak at the National Predictive Modeling Summit. Both presentations will educate attendees on how incorporating advanced technologies, into the health care claims review, provider enrollment and investigation workflows enable commercial and government health care participants to reduce fraud, and improve expensive investigative resources while maximizing recoveries.

LexisNexis offers a comprehensive suite of health care solutions, including comprehensive identity management, social and predictive analytics and data enrichment that help uncover complicated fraud schemes and collusion to assist organizations comply with new regulatory requirements.

Additional information on the LexisNexis presentations:

What the Rules Can't See Can Hurt You
Bill Fox, senior director of health care
Ken Cunningham, VP and segment general manager
Tuesday, November 8, 4:45 p.m. Eastern Time

Mr. Fox and Mr. Cunningham will explore how analytics, including predictive modeling can be a valuable addition to effectively combating fraud, waste and abuse by:

  • Identifying additional claim edits beyond the standard edits to modify or stop payments on claims before they are made
  • Identifying problem claims or providers that can be targeted either post-pay and pre-pay based on complex patterns in the diagnosis, treatment and billing pattern of the providers that are not easily captured in rules
  • Helping to improve investigation or bill audit workflow by prioritizing bills or providers for follow-up

The Next Wave: The Role of Social Networking Analytics in Predictive Modeling
Clint Fuhrman, senior director of government health care
Wednesday, November 9, 4:00 p.m. Eastern Time (Post-conference Symposia)

Mr. Fuhrman will discuss the use of social network analytics to:

  • Enhance traditional predictive modeling improving government health care agencies’ ability to aggregate, analyze and link vast amounts of data quickly and accurately.
  • Leverage public records data bases in conjunction with social network analytics to uncover previously hidden relationships between entities, assets and people
  • Enable investigations that reveal the hidden roots of fraud within a provider network as opposed to the traditional claim by claim approach

National Predictive Modeling Summit
Renaissance Washington, DC Downtown
999 9th Street, NW
Washington, DC 20001

About LexisNexis Risk Solutions
LexisNexis Risk Solutions ( is a leader in providing essential information that helps customers across all industries and government predict, assess and manage risk. Combining cutting-edge technology, unique data and advanced scoring analytics, we provide products and services that address evolving client needs in the risk sector while upholding the highest standards of security and privacy. LexisNexis Risk Solutions is part of Reed Elsevier, a leading publisher and information provider that serves customers in more than 100 countries with more than 30,000 employees worldwide.

Our health care solutions assist payers, providers and integrators with ensuring appropriate access to health care data and programs, enhancing disease management contact ratios, improving operational processes, and proactively combating fraud, waste and abuse across the continuum.

Media Contact
Regina Haas
LexisNexis Risk Solutions

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