Fraud Detection & Prevention for Government Healthcare

Data-driven solutions built to reduce fraud, waste and abuse across government healthcare payer systems

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Data-driven solutions built to reduce fraud, waste and abuse across government healthcare payer systems.

Government investigators rely on vast experience, sharp instincts, unwavering persistence, fraud analytics tools to uncover wrongdoing, but they are often limited by shrinking budgets, large workloads, and resource constraints amidst increasing program participation.

Keep Fraud, Waste, and Abuse (FWA) Under Control

Even as the country is in the middle of the COVID-19 crisis, we find that FWA persist, particularly undermining government-funded healthcare programs.

While instincts and hard work are invaluable, using the right tools makes all the difference in curbing FWA efforts and protecting government healthcare programs, patients, and taxpayers. Successful fraud detection solutions and prevention strategy must build on expansive data intelligence solutions and infuse non-traditional data, extending beyond claims and encounter data.

Armed with comprehensive data and sophisticated analytics, investigators can:

  • Address fraud prevention before it is perpetrated
  • Connect seemingly unrelated actors to expand the investigation impact
  • Identify and respond efficiently to FWA infractions once they have occurred
  • Prioritize limited investigation resources effectively
  • Flexibly navigate a complex and ever-changing landscape

LexisNexis® Fraud Detection and Prevention Suite for Government Healthcare leverages decades of identity, healthcare, business/provider, and relationship information to help government units reduce their exposure to FWA. Our data expertise further empowers the FWA professionals’ investigative expertise, delivered safely and seamlessly right to their desktops. Using billions of public and proprietary records, we deliver unmatched data-driven identity intelligence on fraudsters to help investigators better detect, identify patterns, claims abnormalities, and determine relationship links.

Fraud Detection and Prevention Suite for Government Healthcare

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Government Healthcare Payers: Strategies for Addressing Provider and Claims Fraud amid COVID-19

A panel of industry experts recently convened to discuss ways to thwart healthcare provider and claims fraud – especially now, when regulations are lax. Here is what they had to say.
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[On Demand] Government Healthcare Payers: Strategies for Addressing Provider and Claims Fraud Amid COVID-19

The COVID-19 pandemic has disrupted the U.S. healthcare system from a clinical, supply chain, operational, business and financial perspective. Medicare, Medicaid and dual-eligible beneficiaries have been particularly hard-hit by COVID-19, and not surprisingly, fraud is rapidly evolving according to the HHS OIG.

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