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LexisNexis® Presents How to Detect and Prevent Health Care Fraud Schemes Using Fraud Detection Analytics at AHIP Institute 2013

June 12, 2013 — Will Address Payer Health Care Fraud and Identity Risk in Implementation of ACA, Launch New Solution Suite

ATLANTA – LexisNexis® Risk Solutions today announced its latest suite of anti-fraud and identity management solutions to help health care payers reduce risks associated with wasteful spending, manual operational processes and lack of transparency across member, claims and provider data.

"With rising medical identity theft and millions of soon-to-be insureds, health care payers are challenged with helping to protect their members and also reduce wasteful administrative spending to meet medical loss ratio requirements," said Harry Jordan, SVP and GM, Health Care, LexisNexis. "LexisNexis has a unique combination of data, analytics and technology to link unexpected information sets enabling payers to verify patients and providers are who they say they are, address fraud, waste and abuse from detection through recovery and meet provisions of the ACA and quality reporting standards."

The suite of LexisNexis health care solutions focus on provider, member and claims management, enabling payers to:

  • Maximize the dollars directed to improving the coordination and quality of care delivered by identifying areas of financial loss and reducing unnecessary administrative costs;
  • Positively impact patient safety, reduce reputational risks, and avoid legal threats by identifying sources of risk; and
  • Accurately identify potential fraudulent activities among providers, members and claims through comprehensive identity and claims analytics tools.

With more consumers entering the health care system and changes like ICD-10, the opportunity for fraudulent activity becomes greater. For payers, the right combination and application of analytics and data sources can improve prevention efforts, reduce associated costs, and improve member satisfaction by ensuring that only trusted providers are in a network. LexisNexis experts Ken Cunningham, Vice President, Analytics, and Russell Streur, Director, Fraud, Waste & Abuse Analytics, present real world applications in the AHIP Institute session, "Maintaining the Integrity of Provider Networks: Detecting Emerging Fraud Schemes with Analytics," on Thursday, June 13 from 3:55 p.m. - 4:45 p.m.

About LexisNexis Risk Solutions
LexisNexis Risk Solutions ( is a leader in providing essential information that helps customers across industries and government predict, assess and manage risk. Combining cutting-edge technology, unique data and advanced analytics, LexisNexis Risk Solutions provides 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 global provider of professional information solutions across a number of sectors. 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
Phone: +1.678.694.3569

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