Rely on provider data that’s accurate, current and accessible

High-quality provider data helps expose healthcare fraud, increase efficiency and reduce operating costs.

Healthcare Provider Fraud


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Provider data is at the center of almost every health plan workflow. 

The quality of that data impacts health outcomes, member satisfaction, compliance and efficiency. It also is critical to detecting healthcare provider fraud and Medicaid fraud. LexisNexis® Risk Solutions is the industry leader in provider data and data management. Our proprietary linking and computing technology allows us to seamlessly aggregate, link and analyze vast sources of data to deliver accurate provider information and actionable insights.

LexisNexis Delivers

Provider Data Cleansing

Eliminates inaccuracies in your provider directory to best serve members and avoid potential penalties.

Proactive Data Monitoring

LexisNexis Provider Data MasterFileTM leverages over 2,000 sources to build, maintain and continually update provider data.

Advanced Visual Analytics

Employs proprietary data linking and computing technology to aggregate, link and analyze data covering more than 10.5 million providers.

Relationship Mapping

Unravels complex relationships and associated fraud schemes by connecting activity between providers, individuals and businesses.

Provider Integrity Scan

Automates a variety of provider verification searches and ongoing monitoring options to discover potentially fraudulent healthcare providers.

Achieve These Results

Combat Fraud

Detect and prevent healthcare provider fraud and Medicaid fraud leveraging LexisNexis data resources, state-of-the-art linking technology and advanced analytics.

Prioritize Investigations

Pursue cases of healthcare provider fraud, waste and abuse that are potentially the most lucrative.

Increase Efficiency

Verify and authenticate providers more quickly using LexisNexis provider data management tools.

Improve Compliance

Meet all CMS requirements and other regulations pertaining to provider data quality.

Close Provider Gaps

Analyze your provider network to identify and plug gaps in service areas.

Reduce Operating Costs

Eliminate wasted time and money spent attempting to contact providers whose information is incorrect or outdated.

Insights and Resources


The State of Provider Directory Accuracy Across the U.S.

Inaccurate data in healthcare provider directories can be costly to state governments.

Preventing Healthcare Provider Fraud and Improper Payments

Our Provider Integrity solution can assist government healthcare programs with both provider enrollment and program integrity efforts.

Helping Investigators Identify Fraud by Healthcare Providers

Our Intelligent Investigator solution can pinpoint claims and provider fraud, waste, and abuse across Medicare and Medicaid programs.
Blog Post

Not Exactly What the Doctor Ordered

Medicare and Medicaid fraud occurs through a number of provider schemes.

We believe in the power of data and analytics
to manage risk & uncover opportunity.

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