Strike a Balance Between Compliance and Efficiency
to Detect Fraud

LexisNexis® solutions facilitate transparency and streamline due diligence to reduce prescription fraud and abuse.

Pharmacy Fraud and Abuse

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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.

Relationship visualization

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.

Conduct investigations

Leverage rules-based analytics to quantify and prioritize which prescription fraud cases to pursue and what resources to allocate.

Operate efficiently

LexisNexis solutions automate pharmacy fraud detection, minimizing manual investigative effort, reducing overpayments and enhancing recoveries.

Insights and Resources


Unravel Complex Relationships and Associated Fraud Schemes by Connecting Activity Between Providers, Individuals and Businesses

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Reduce Exposure to Claims Fraud with Integration of Public Records

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