Prevent fraud, waste and abuse in Medicaid & CHIP programs

Use a multi-layered approach to detect identity theft and fraud, preserving program funding and integrity.

Medicaid and CHIP


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Each year fraud in Medicaid and Children’s Health Insurance Programs (CHIP) costs taxpayers billions. 

Sometimes fraud is perpetrated by individuals using stolen identities or misrepresenting the truth to obtain benefits. Other times, it’s committed by providers billing for services not rendered, pharmacies over-charging or organized crime rings using complex schemes. LexisNexis ® Risk Solutions offers the technology needed to prevent improper payments and ensure program integrity.

LexisNexis Delivers

Identity Verification

Authenticating applicants and beneficiaries is a reliable process fueled by 37 billion records linked from 10,000 data sources.

Early Detection

Checks and balances incorporated into workflows stop improper payments to beneficiaries and providers, which is more effective than pay-and-chase.

Multi-layered Approach

Using a variety of methods to verify identities provides multiple opportunities to catch and weed out fraudulent claims.

Predictive Analytics

Translating data into models using various forms of analysis helps identify fraud patterns and risk indicators as they emerge.

Provider Integrity

Unique public data and advanced linking technology verify the right providers are paid for the appropriate services on eligible beneficiaries.

Incorporating External Data

Integrating external data with agency data gives a broader, more accurate view of applicants and beneficiaries.

Achieve These Results

Provide Much-needed Assistance

Help low-income families, children, elderly and disabled populations that meet program qualifications receive benefits.

Protect Identities

Limit and control access to critical information within the agency, protecting beneficiaries’ personal data.

Detect and Prevent Fraud

Ensure benefits only go to those who are entitled by verifying applicant identities and information before payments are made.

Strengthen Program Integrity

Stop improper payments and overpayments that drain public assistance programs and waste taxpayer money.

Improve Productivity

Process applications quickly and efficiently without compromising security measures to prevent fraud.

Optimize Resources

Prioritize fraud investigations to focus on cases that are likely to be lucrative and worthwhile.

Insights and Resources


Prevent Dual Participation

Learn how the National Accuracy Clearinghouse can assist states with the identification and prevention of dual participation across Medicaid and CHIP programs.

Beyond HIPAA

How data sharing among states can prevent fraud and improve the integrity of state public assistance programs like Medicaid.
News Article

Medicaid Fraud @ Fraud of the Day

Keep up-to-date with articles about Medicaid fraud schemes occurring in your state.
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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