LexisNexis® Provider Integrity Scan Identifies Fraudulent Providers and Organizations, Reduces Health Care Payer Costs

For LexisNexis Risk SolutionsCohn & WolfeStephen M. Brown, 404-260-3514

LexisNexis Risk Solutions today announced the availability of LexisNexis Provider Integrity Scan, an advanced data solution to assist private and public health care payers in verifying and monitoring health care provider licensing and credentials, and detecting and preventing fraudulent or criminal provider activity. Organizations using Provider Integrity Scan benefit from reduced health care costs by identifying potentially fraudulent providers and businesses enrolled or attempting to enroll in health-related programs.

In today’s health care environment, if an improper claim payment is made, health plans have a less than 50 percent chance of recovering the funds. CMS estimates Medicaid fraud, waste, and abuse alone to be over $30 billion annually, while NHCAA estimates conservatively that overall fraud accounts for 3 percent of our nation's annual health care spending or approximately $69 billion. These factors require health plans to systematically monitor payment activities and diligently ensure that the risk of improper payments and other forms of provider fraud is reduced.

“Health care payers continue to be challenged with increasing regulations from the Centers for Medicare and Medicaid Services (CMS) to ensure enrollment is limited to legitimate providers and suppliers, pending standards within state agencies and rising losses associated with fraud and improper payments,” said Harry Jordan, vice president and general manager, health care, LexisNexis. “Knowing the best way to reduce fraud, waste, and abuse is to prevent it, LexisNexis helps payers take a proactive approach to uncovering derogatory attributes linked to providers. This approach reduces a payer’s exposure to fraud before it impacts their bottom line, regulatory compliance and patient safety.”

LexisNexis Provider Integrity Scan automates a variety of provider verification searches and ongoing monitoring options, and provides automatic red flag alerts for a wide range of high risk indicators. It gives payers the ability to efficiently process multiple searches and obtain critical information contained within massive volumes of provider data within the nation’s public and private health plans.

The solution offers payers efficiency in processing power, utilizing LexID and access to more than 40 billion public and proprietary records from more than 10,000 sources. LexID is among the fastest linking technology available, enabling customers to identify, organize information quickly and link records together. This speed and accuracy is important in combating fraudulent providers who use family and cohorts to set up new businesses in other cities or states once they’ve been flagged or sanctioned by health care payers.

For more information about LexisNexis Provider Integrity Scan, please visit .

LexisNexis Risk Solutions () is a leader in providing essential information that helps customers across all industries and government predict, assess and manage risk. Combining cutting-edge technology, unique data and advanced scoring analytics, Risk Solutions provides products and services that address evolving client needs in the risk sector while upholding the highest standards of security and privacy. LexisNexis Risk Solutions is part of Reed Elsevier, a leading publisher and information provider that serves customers in more than 100 countries with more than 30,000 employees worldwide.

Our health care solutions assist payers, providers and integrators with ensuring appropriate access to health care data and programs, enhancing disease management contact ratios, improving operational processes, and proactively combating fraud, waste and abuse across the continuum.