The rate of health care fraud, waste and abuse continues to rise. Schemes are becoming more complex involving multiple players and hard to find patterns. How healthcare organizations respond to this issue has become a priority to departments beyond the Special Investigation Units (SIU).

Detection and prevention begins with understanding how patients and providers are entering, engaging and behaving as they move through the health care ecosystem. Our multi-layered approach and robust suite of health care fraud analytics applies distinctive capabilities to help identify and reduce fraud related to provider, claims and member schemes; new member enrollment via Health Exchange Marketplaces; complex billing schemes; and fraud rings

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®, is a Premier Supporting Member of the National Health Care Anti-Fraud Association and Select Member of the Association of Health Insurance Plans (AHIP).

1. Lovelace Health Plan Case Study
2. LexisNexis® Payment Protection Approach Transforms Health Insurance Pay-and-Chase Fraud Recovery Model Into a Precision Pre-Pay Fraud Prevention Solution

1. The Real Cost of Health Care Fraud - And New Ways to Fight It
   Stopping the Flow of Health Care Fraud with Technology, Data and Analytics
2. Key Factors for Payers in Fraud & Abuse Prevention
   Protect against fraud and abuse with a multi-layered approach to claims management
3. Public Records for Health Care
   Reduce exposure to claims fraud with integration of public records
4. Bending the Cost Curve: Analytic Driven Enterprise Fraud Control
   Three percent, or $60 billion, of all health care spending is lost to fraud.
5. The Rise of Organized Crime in Health Care: Social Network Analytics Uncover Hidden and Complex Fraud Schemes
   Experience the power of data, linking and analytics
6. Enhanced data for more powerful fraud prevention

• Connecting Fraud Schemes with the People Leading Them
• Enhanced Data for More Powerful Fraud Prevention

Accurint® for Health Care

Protect against fraudulent claims and identity fraud

LexisNexis® InstantID® for Healthcare

Identify fraud risks across exchanges and broker communities

Intelligent Investigator™

Pinpoint fraud with confidence

PrePayment Manager™

Identify improper payments before disbursement

Relationship Mapping

Identify hidden relationships that may indicate fraud

Trail Tracker™

Track cases and improve recovery

Virtual SIU™

Grow your investigative capabilities