Bill Fox Addresses the Use of Social Network Analytics to Uncover Organized Crime Health Care Fraud Rings
NEW YORK--(BUSINESS WIRE)-- LexisNexis® Risk Solutions will showcase Social Network Analytics, a new advanced analytic tool, at the National Health Care Anti-Fraud Association (NHCAA) Institute’s Annual Training Conference Nov. 15-18, in Atlanta, Georgia. In his conference presentation, Bill Fox, senior director, health care, will address how Social Network Analytics enables commercial and government payers to combat fraud, waste and abuse in a broader, more transparent way than traditional approaches.
LexisNexis will examine how Social Network Analytics:
- Provides insight into networks of businesses and individuals perpetrating health care fraud, going beyond mere linking or visualization
- Can be deployed to reveal and visualize hidden collusion using real case studies
- Drives higher workflow ROI within government and commercial payers
“Finding organized, collusive health care fraud is critical to stemming health care fraud and protecting consumers, medical providers and government and commercial payers,” said Fox. “Social Network Analytics represents the latest frontier in technology solutions that enable members of the health care industry to identify and prevent fraud, waste and abuse.”
Health care fraud is on the rise. Organized crime is finding the big money, access to electronic records and low penalties just too tempting to pass up. Social Network Analytics can bring visibility to hidden relationships utilizing a company’s internal data, but also leveraging “big data” outside what the company already knows. Public records data and derived and risk scored data sets can reveal hidden relationships between people, assets, entities, property and medical providers. This information can be used to stop collusion within a payer’s network that might otherwise remain hidden, costing untold amounts and endangering patient safety.
LexisNexis (booths 127 and 129) offers the industry a comprehensive portfolio of health care solutions – including identity proofing and user authentication, data linking, and predictive analytics – all of which help health care providers, consumers and payers identify and address medical identity theft and health care fraud.
About LexisNexis Risk Solutions
LexisNexis® Risk Solutions (www.lexisnexis.com/risk/) 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, we provide 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.
LexisNexis Risk Solutions
Regina Haas, 678-694-3569
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