Solutions for Fighting  
Healthcare Fraud, Waste
and Abuse

Fight healthcare fraud and strengthen investigations with powerful data analytics and visualization technology.

Fraud Waste and Abuse Detection

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Losses from healthcare fraud, waste and abuse are estimated in the hundreds of millions of dollars per day.

LexisNexis data solutions aggregate, analyze and link data from thousands of sources and reveal suspicious, hidden connections between members, doctors and claims across their programs. With unprecedented visibility, payers can prioritize response, optimize resource allocation and investigate potential fraud more effectively.

Quickly uncover complex fraud schemes

Identify potentially fraudulent providers and businesses enrolled or attempting to enroll in health-related programs.

Accurately link providers, members and claims

Discover hidden relationships between individuals, businesses, assets and properties that warrant investigation for fraud.

Identify social groups indicative of fraud rings

Leverage social network analytics to connect questionable individuals, providers and medical facilities.

Protect against fraudulent claims and identity-based fraud

Process and investigate claims more quickly and efficiently to reduce financial losses.

Reduce risk of marketplace enrollment fraud

Accelerate account openings with fast identity verification and enhanced due diligence.

Expand and complement SIU resources

Add robust investigative resources that leverage proprietary data to identify and curb healthcare fraud.

Insights and Resources

Case Study

Lovelace Health Plan Looks to Make Significant Recoveries from Fraud, Waste and Abuse Activities

White Paper

Contributory Databases: What Healthcare Insurers Should Know

White Paper

A Systematic Approach to Combat Healthcare Identity Fraud

Video

See the Benefits of LexisNexis Relationship Mapping

Infographic

Fight Healthcare Fraud with Data and Analytics

Video

Detect and prevent fraud and with Intelligent Investigator

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

Payer Fraud NPS Quote

“LexisNexis understands my business and is easy to do business with. I feel valued as a customer.”

Health plan customer
of LexisNexis fraud, waste and abuse solutions