Health Care


By Segment

By Capability

LexisNexis® applies distinctive capabilities to help payers reduce wasteful spending and improve efficiency, while evolving their fraud, waste and abuse programs. Our suite of tools aids in health care payment protection by detecting new patterns and by putting up blocks for emerging patterns of fraud, waste and abuse in both the pre and post pay environment. By leveraging more than 45 billion public records from over 10,000 data sources, the industry’s leading source of provider data and a powerful computing platform and intuitive user interface, 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
  • Ability to identify possibly fraudulent exchange enrollment

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.

  1. Enhanced Data for More Powerful Fraud Prevention
  2. 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
  3. Key Factors for Payers in Fraud & Abuse Prevention
    Protect against fraud and abuse with a multi-layered approach to claims management
  4. Public Records for Health Care
    Reduce exposure to claims fraud with integration of public records
  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

LexisNexis® InstantID® for Healthcare
Identify fraud risks across exchanges and broker communities
Provider Integrity Scan
Know your providers, reduce risk, and prevent fraud.
Relationship Mapping
Identify hidden relationships that may indicate fraud