Healthcare fraud schemes continue to become more complex. Organized crime, as well as complex billing and referral schemes, make finding healthcare fraud a challenge for even the savviest investigator. Special Investigations Units (SIUs), Program Integrity and Medicaid Fraud Control Units often do not have the necessary resources to investigate all claims, which hinders their ability to identify and research fraud schemes in a proactive and efficient manner. This allows healthcare fraud schemes to flourish, costing the United States healthcare system billions each year.
LexisNexis® Intelligent Investigator™ is an advanced healthcare fraud, waste and abuse detection and investigation tool that uses sophisticated rules-based analytics to identify and prioritize the cases that are potentially most likely to achieve the best recovery results.
Results are delivered through a powerful web-based portal that provides dashboard summaries of domain specific information through graphs, bar, and pie charts. Special screens have been built in to assist investigators in identifying fraudulent providers or claims based on partial information from tips and leads.
LexisNexis Intelligent Investigator™ pinpoints suspicious behavior across all healthcare claim types, including medical, facility, pharmaceutical and dental. The easy-to-use interface allows users to trace leads by provider, member/patient and transaction.
Research Claims Across Systems in a Single View
Get it now: For more information about Intelligent Investigator, please call 866.396.7703.