Healthcare Billing Fraud Detection Case Study

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LexisNexis Intelligent Investigator helped a large healthcare payer uncover fraudulent overpayments.

Complex healthcare billing fraud schemes are often difficult to detect because of the mountains of siloed data in disparate systems. Connecting the dots, using a tool like Intelligent Investigator, can help health plans quickly see suspicious activity, like fraudulent prescribing patterns and overpayments.

This case study will detail how a health plan’s fraud investigators used LexisNexis® Intelligent Investigator™ to analyze medical and pharmacy claims—and turned mountains of data into the precise intelligence they needed to uncover billing fraud. LexisNexis Intelligent Investigator showed them the extent of the problem—so they could act immediately to fix it—by pinpointing suspicious behavior across all claim types. Its easy-to-use interface allowed the SIU to drill deep into the data to see how often one doctor was prescribing a specific drug, to which patients—and at what cost to the plan.

Read about why one Special Investigations Unit now considers LexisNexis Intelligent Investigator “invaluable” to quickly find, stop and mitigate fraudulent billing activity.

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