According to the National Health Care Anti-Fraud Association, fraud accounts for $70 to $234 billion a year—about $190 to $640 million per day. Health care payers are challenged with meeting prompt-pay laws and meeting Medical Loss Ratio requirements with limited resources.
The approach to detecting, identifying and preventing fraud, waste and abuse is shifting and becoming a priority to departments beyond Special Investigation Units (SIU). LexisNexis applies distinctive capabilities to help payers reduce wasteful spending and improve efficiency, while evolving their fraud, waste and abuse programs. Our suite of pre- and post- pay tools to detect new patterns, uncover new patterns and put up blocks for emerging patters of fraud, waste and abuse in both the pre and post pay environment. Leveraging more than 37 billion public records from over 10,000 data sources, the industry's leading source of provider and a powerful computing platform and intuitive user interfaces LexisNexis delivers:
- A 360 degree view of member, provider and claim for deeper dive into data
- Prioritized leads thru provider level scoring
- Ad-hoc and embedded reporting, with rules development at the desktop
- Transparency into causes of suspicion
In addition to our workflow solutions, LexisNexis offers supplemental SIU services to augment and support internal investigative efforts. Our Virtual SIU team helps triage investigations, conduct medical records review and more.
LexisNexis®, a Premier Supporting Member of the National Health Care Anti-Fraud Association and the Association of Health Insurance Plans (AHIP) Select Member, offers a multi-layered enterprise approach to fraud, waste, and abuse identification and prevention.
To learn more about our Fraud, Waste and Abuse solutions or to receive pricing information:
- Accurint® for Health Care
- Protect against fraudulent claims and identity fraud
- Bridger Insight® XG for Health Care
- Conduct due diligence, comply with global regulations and reduce fraud risks
- Instantly validate provider data on inbound claims
- Claims Indexing
- Track providers across claims in a data warehouse
- Intelligent Investigator™
- Pinpoint fraud with confidence
- PrePayment Manager™
- Identify improper payments before disbursement
- Provider Integrity Scan
- Know your providers, reduce risk, and prevent fraud.
- Provider of Interest Score
- Identify aberrant patterns in provider behavior
- Relationship Mapping
- Identify hidden relationships that may indicate fraud
- Solutions for Exchange Fraud
- Identify fraud risks across exchanges and broker communities
- Trail Tracker™
- Track cases and improve recovery
- Uncover HCP to HCO to Corporate Parent Affiliations
- Virtual SIU™
- Grow your investigative capabilities