With new CMS mandates, increasing pressure is being placed on Pharmacy Benefits Managers (PBMs) to identify fraudulent providers, moving away from a pay-and-chase system to a preventive model. To prevent pharmacy benefits fraud before it happens, PBMs must ask important questions about each of the providers in their network. But it does not stop there. Perpetrators of healthcare fraud often design elaborate schemes that make claims appear legitimate, forcing PBMs to continually sharpen their oversight capabilities.
The best pharmacy benefits fraud protection for PBMs lies in knowing their provider network. Data, analytics and cutting-edge technology now make that possible. Read about how LexisNexis works with PBMs to verify healthcare provider licensing and credentials to detect fraudulent or criminal provider activity.
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