With ever-growing regulations and increasing areas of prescription fraud, waste and abuse, today’s pharmacies and pharmacy benefit managers must find a balance between risk mitigation and operating efficiency.
LexisNexis® offers a multi-layered approach to help identify and reduce prescription fraud related to provider, claims and member schemes; new member enrollment via Health Exchange Marketplaces; complex billing schemes; and organized fraud rings.
Combine visualization capabilities, disparate data and linking technology to resolve identities and uncover relationships that may suggest prescription fraud.
See suspicious connections
Discover inappropriate or questionable links between patients, providers, employers, suppliers and partners that warrant further investigation.
Uncover collusive schemes
Through data linking, unravel complex prescription fraud conspiracies perpetrated by organized crime groups.
Detect suspicious behavior
Get flagged on unusual prescribing practices, aberrant dispensing patterns and drug-seeking behavior that may suggest illegal activity.
Leverage rules-based analytics to quantify and prioritize which prescription fraud cases to pursue and what resources to allocate.