LexisNexis Identifies Top Trends in Health Care Fraud, Waste and Abuse

ATLANTA--(BUSINESS WIRE)--LexisNexis^® Risk Solutions announced today its list of top trends in health care fraud, waste and abuse and will discuss how to leverage technology to address them at the 2012 Annual HIMSS Conference & Exhibition Feb. 20-24 in Las Vegas, Nevada.

“Unfortunately, it's a reality that fraud is one of the drivers of the rising costs of health care in both the private and public sectors”

Top Health Care Fraud, Waste and Abuse trends include:

The rise of organized crime in health care fraud – In recent years, criminals have migrated from illegal drug trafficking to perpetrating fraud schemes against Medicare, Medicaid and private health insurance companies.
Increased fraud vulnerabilities due to migration to EHRs and ICD-10 – Concerns surrounding medical identity theft and data privacy are increasing as personal health information (PHI) goes electronic.
Crackdown on improper payments, led by the Centers for Medicare & Medicaid Services (CMS) – In addition to recovering improper payments and reducing payment errors, new provider enrollment rules under the Affordable Care Act (CMS Rule 6028) seek to ensure that providers and suppliers are screened for their risk of committing fraud, waste, and abuse before being allowed to enroll in federal programs.
The need for better patient information – With general statistics showing that 5-10% of individual contact information provided by commercial carriers is incorrect and 25-30% of individual contact information provided by Medicare is incorrect, it’s no wonder that payers are challenged with HEDIS reporting and providers’ revenue cycles.
Increased medical identity theft – Consumers’ increased use of online and mobile tools, along with Personal Health Records (PHRs), can open doors to theft and create even greater risk to misuse of information. Medical identity theft and health care fraud are a significant burden on the United States health care system with industry reports showing the annual cost of fraud in the U.S. estimated to be between $60 and $200 billion.

Among the top technology solutions to help health care payers, providers and patients identify and eliminate fraud at the beginning of the health care cycle before care is given, include:

Social Network Analytics or data analytics
predictive modeling
pre-payment claims analytics
advanced credentialing and identity management systems

“Unfortunately, it's a reality that fraud is one of the drivers of the rising costs of health care in both the private and public sectors,” said Harry Jordan, vice president of health care for LexisNexis. “Proactively preventing fraud benefits everyone – patients, providers, and payers. It enables the health care community to focus on delivering high quality care, and helps mitigate the increasing costs of that care.”

Leading the HIMSS Fraud Waste & Abuse (FWA) discussion, LexisNexis experts have been asked to speak on the following:

Openness and Exactness - Mitigating Fraud Vulnerabilities in the Age of EHRs and ICD-10 Tuesday, February 21, 2012, 3:30 p.m. - 4:30 p.m.
Casanova 502
What are the vulnerabilities created by the migration to an environment of open exchange of health information and complex coding? What steps does your organization need to take today to mitigate and monitor these vulnerabilities to prevent risk - financial, reputational and patient safety?
Defeating Organized Crime with Social Network Analytics
Wednesday, February 22, 2012, 9:45 a.m. - 10:45 a.m.
Lando 4303
Organized crime has discovered health care. Social Network Analytics can help reveal complex hidden schemes that threaten the financial and reputational health of your organization and the safety of your patients.
ICD-10 Knowledge Center: Ask the FWA Experts
Hall G, Booth 14542
Wednesday, February 22, 2012, 2:45 p.m. – 3:30 p.m.
Thursday, February 23, 2012, 3:30 p.m. – 4:00 p.m.
Providers and ICD-10: Mitigation Strategies for FWA
HIMSS Knowledge Center
Wednesday, February 22, 2012, 2:45 p.m. – 3:30 p.m.
Hall G, Booth 14542
Interoperability Showcase: Risk Mitigation in an ICD-10 World
Thursday, February 23, 2012, 9:45 a.m. – 10:15 a.m.
Theater - Hall G, Booth 11000

Attendees can also visit the LexisNexis booth (#5225) to speak with our experts about the current state of fraud, waste and abuse in the health care industry and the available solutions available to health care payers, providers and patients to address these challenges.

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.