Relationship Mapping

Identify hidden relationships that may indicate fraud


Health care fraud drains billions of dollars from the United States every year and continues to escalate as the scope of the industry expands.

Payers need to be able to visualize the highly suspect and hidden connections between members, doctors and claims across their programs.

Relationship Mapping aggregates, analyzes and links data from vast sources to provide a view into significant relationships between individuals, businesses, assets and properties that warrant further investigation.


Benefits

Health care organizations face many operational challenges – spending waste, reporting concerns, member safety, fraudulent claims and more. Many of these challenges could be better negotiated or avoided if payers were able to identify the hidden causes. Relationship Mapping takes customer claims, along with provider and socio-economic data from LexisNexis, to present a clear picture of the complex relationships that stakeholders should be aware of.

  • Prevent improper claims payments and overpayments, and improve recoveries
  • Uncover fraud attempts, including larger collusive schemes perpetrated by organized crime groups
  • Reveal inappropriate or suspect relationships between patients, providers, employers, suppliers and partners
  • Discover non-licensed providers
  • Better allocate valuable resources
  • Detect unusual prescribing habits, aberrant dispensing patterns and drug seeking behavior


Features

Relationship Mapping is a powerful solution that combines visualization capabilities, disparate data types and proprietary linking technology to accurately resolve identities and uncover hidden relationships.

  • Utilizes social network analytics to identify hidden patterns of information sharing and interactions within potentially fraudulent clusters
  • Triages connections that merit closer scrutiny for prioritization
  • Proprietary linking reveals both known and unknown entities  
  • Suspect address module displays suspect billing activities

Get it now: For more information about LexisNexis® Relationship Mapping, call 866.396.7703.

 

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See the Benefits of LexisNexis Relationship Mapping

The LexisNexis Relationship Mapping services are not provided by “consumer reporting agencies,” as that term is defined in the Fair Credit Reporting Act (15 U.S.C. § 1681, et seq.) (“FCRA”) and do not constitute “consumer reports,” as that term is defined in the FCRA. Accordingly, the LexisNexis Relationship Mapping service may not be used in whole or in part as a factor in determining eligibility for credit, insurance, employment or another purpose in connection with which a consumer report may be used under the FCRA.

Due to the nature of the origin of public record information, the public records and commercially available data sources used in reports may contain errors. Source data is sometimes reported or entered inaccurately, processed poorly or incorrectly, and is generally not free from defect. This product or service aggregates and reports data, as provided by the public records and commercially available data sources, and is not the source of the data, nor is it a comprehensive compilation of the data. Before relying on any data, it should be independently verified.