LexisNexis® Provider of Interest Score supports investigators by identifying providers with irregular diagnosis, treatment and billings patterns, highlighting data points where the provider is an outlier from his/her peers, and augmenting data on identified providers with public records such as financial, criminal and medical-sanction derogatory information.
Predictive modeling, as employed by LexisNexis® Provider of Interest Score, utilizes statistical techniques to identify combinations of factors that should be analyzed as fraud, waste and abuse indicators. Scoring then prioritizes results, focusing on areas that have the highest probability of fraud, waste and abuse.
LexisNexis® Provider of Interest Score is customized for each organization, taking into account their individual policies and available resources. Models can be based on previously identified fraud, waste and abuse or built without identified problems. Custom models can also address factors such as differences in diagnosis and treatment patterns by geography.