Health Insurance Fraud and Abuse: Key Factors for Payers

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With the rising cost of health care fraud and abuse, there is corresponding movement among health insurers from simple detection to active prevention. At LexisNexis, we believe avoiding the pay-and-chase treadmill is dependent on real-time access to wide ranging information sources, integrating internal and external data, to identify fraudsters before paying a claim.

To succeed, you need the right tools to validate charges before issuing a payment - without derailing the process for valid claims. In this study, we outline the five key factors that can help you take the initiative in detecting and preventing fraud and abuse, all while ensuring secure information management, containing costs and minimizing false-positive results.

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