LexisNexis® Risk & Information Analytics Group Launches Medicare/Medicaid Fraud Solution
December 8th, 2008
2008 DEC 8 -- LexisNexis Risk & Information Analytics Group announced LexisNexis® MediFraudAlert™, a solution that provides administrators with the information to rapidly validate claims and prevent Medicare and Medicaid fraud. The solution addresses the challenges of fraud by making it easy for administrators to quickly check provider and beneficiary status and relationships for potential indicators of fraud before payments are made.
The ability of the solution to spot potential fraud was recently verified by a study LexisNexis Risk & Information Analytics Group conducted with the Centers for Medicare and Medicaid Services (CMS). The study analyzed five years of claims from two states and found that more than 4% of the claims – representing $3.23 billion – were fraudulent or were highly indicative of potential fraud.
According to the National Center for Policy Analysis, Medicare and Medicaid lose an aggregate of $33 billion each year to fraud. Fraudulent activity ranges from claims filed using the identifiers of deceased physicians and claims made from physicians with expired licenses, to phony addresses and claims filed on behalf of deceased beneficiaries. A recent Senate investigation revealed almost $93 million in fraudulent payments stemming from prescriptions for durable medical equipment (DME) 'issued' by doctors who were deceased.
LexisNexis MediFraudAlert helps solve this problem by providing administrators with the information and ability to instantly verify:
• Claimant identity (ensuring claimants are who they claim to be)
• Whether providers or beneficiaries are deceased or were deceased at the time services were rendered
• Whether businesses claiming to offer DME and/or medical services are legitimate and licensed
• Eligibility of Medicare recipient
"Fraud siphons millions of dollars a year out of Medicare and Medicaid, jeopardizing the ability of these programs to serve the public and ensure a high quality of care to those who need it," said Haywood Talcove, chief executive officer, LexisNexis Special Services. "LexisNexis MediFraudAlert helps solve this problem by giving administrators the tools to spot fraud before claims are authorized and payments are made."
LexisNexis MediFraudAlert leverages public records and integrates those records with agency data sources to ensure the most current and comprehensive eligibility reporting. The solution features advanced data analytics technology to ensure fast, accurate results and to fit easily into existing agency workflows without disruption.
With the release of LexisNexis MediFraudAlert, the company is reaffirming its commitment to provide solutions that transform government's ability to use information to serve the public. LexisNexis helps federal, state and local government accomplish mission-critical tasks through advanced tools and solutions and specializes in areas including law enforcement, public safety, tax and revenue, and health and human services.
About LexisNexis
LexisNexis® (www.lexisnexis.com) is a leading global provider of content-enabled workflow solutions designed specifically for professionals in the legal, risk management, corporate, government, law enforcement, accounting, and academic markets. LexisNexis originally pioneered online information with its Lexis® and Nexis® services. A member of Reed Elsevier [NYSE: ENL; NYSE: RUK] (www.reedelsevier.com), LexisNexis serves customers in more than 100 countries with 18,000 employees worldwide.
About LexisNexis Risk & Information Analytics Group
LexisNexis Risk & Information Analytics Group is a natural extension of the core competencies and technologies proven in the LexisNexis online products from the past 30 years. The LexisNexis Risk & Information Analytics Group builds on the LexisNexis tradition as a trusted provider and custodian of quality information, and leverages new cutting-edge technology, unique data and advanced scoring analytics to create total solutions to address client needs.
LexisNexis Risk & Information Analytics Group is specifically designed to serve the multi-billion dollar risk information industry which is comprised of professionals and organizations such as law enforcement, government agencies, financial services firms, collection agencies, insurance and health care providers, hiring managers, and other professionals.
Keywords: Medicare and Medicaid, Health Policy, Medicaid, Medicare, Quality of Care.
This article was prepared by Managed Care Weekly Digest editors from staff and other reports. Copyright 2008, Managed Care Weekly Digest via NewsRx.com.
