Health Care

Create an environment that controls the risk of fraud.

Leverage Identity Management, Fraud Prevention and Data Analytics for Your Health Care Program

Government health care programs such as Medicare and Medicaid and State Children’s Health Insurance Programs are facing rising enrollment, reduced budgets and new mandates. And health care reform will result in millions of new consumers entering the health care system. Finding efficient ways to enhance enrollment processes, minimize fraud, waste and abuse, drive improved program integrity and ensure accessibility is critical.

In the past, government health agencies have relied primarily on post-payment solutions. Health care reform, increased regulation and financial pressures have made this “pay and chase” model insufficient and unsustainable. Agencies with limited resources can enhance program integrity by leveraging external data sources, identity management tools and innovative data analytics to prevent improper payments before they occur.

  • Health care industry experts have estimated that if the U.S. health care system uses big data to drive efficiency and quality, it could generate annual health care savings of more than $300 billion.

LexisNexis® Health Care Solutions use an enterprise approach to help agencies create an environment that controls the risk of fraud. Checks and balances incorporated at various points throughout existing workflows identify risk as beneficiaries and providers use the system. Our innovative approach incorporates:

Comprehensive identity management

Deploy solutions that help you verify identities of providers and beneficiaries prior to enrollment and review their status over time.

Predictive analytics

Enhance traditional data mining techniques and post-payment methodologies with our sophisticated modeling capabilities, which help identity fraud patterns and risk indicators as they emerge.

Data enrichment and hygiene

Update existing information concerning providers, the medical services they offer and the beneficiaries
they treat.

Address Modern Challenges with Social Network Analytics

Leverage unique public data and advanced linking identity analytics to reveal hidden relationships and schemes among providers, facilities and beneficiaries.

With our integrity solutions, you benefit from:

  • Early detection of fraud, waste and abuse
  • Prioritized results with fewer false positives, which enable more efficient use of
    investigative resources
  • Alerts concerning adverse changes in the status of individuals or entities accessing your benefits
    or network
  • Confidence in knowing that the right providers are being paid for the appropriate services on
    eligible beneficiaries
  • Lower claims losses, better cash flow and higher return on investment (ROI) than traditional
    "post-payment only" methods

Advantages of LexisNexis

Our predictive analytics have been delivering a high ROI and measurable results on medical claims in the insurance payer market for years. Our models have helped detect emerging fraud and empowered stakeholders to reduce waste and inefficiency.

With access to more than 10,000 data sources and over 37 billion records in our database, we work with you to identify the personal and business connections that are critical to a fraudulent scheme’s success
or failure.

Request an Identity Solutions Demonstration

We have analyzed hundreds of millions of identities across dozens of federal, state and local systems for identity risk, and are the global leader
in mitigating identity risks. Learn how others have done it through an identity solutions demonstration today.

Get Your Demonstration!