Lovelace Health Plan Looks to Make Significant Recoveries From Fraud, Waste and Abuse Activities with LexisNexis® Anti-Fraud Services and Technology
Company Size
1,000+
Region
- America
Country
- United States
Product
- Virtual SIU
- Intelligent Investigator
Tech Stack
- Advanced Fraud Detection System
- Customizable Education Platform
Implementation Scale
- Enterprise-wide Deployment
Impact Metrics
- Cost Savings
- Customer Satisfaction
- Productivity Improvements
Technology Category
- Analytics & Modeling - Predictive Analytics
- Application Infrastructure & Middleware - Data Exchange & Integration
- Functional Applications - Enterprise Resource Planning Systems (ERP)
Applicable Industries
- Healthcare & Hospitals
Applicable Functions
- Business Operation
- Quality Assurance
Use Cases
- Fraud Detection
- Regulatory Compliance Monitoring
- Remote Asset Management
Services
- System Integration
- Training
About The Customer
The Albuquerque-based Lovelace Health Plan provides insurance coverage for more than 210,000 members in communities across New Mexico. It is part of the Lovelace Health System, which includes six hospitals. Lovelace offers a broad range of health plan options and programs, as well as coverage with a continually expanding network of providers and health care centers.
The Challenge
To meet the rising threat of health care fraud, Lovelace sought a robust solution to maximize its detection abilities.
The Solution
The SIU Compliance Officer, Paul Peoples, teamed up with LexisNexis to understand how to optimize the use of the company’s Virtual SIU™ investigative services and Intelligent Investigator™ advanced fraud detection system. Virtual SIU gathers, analyzes and manages fraud-related data. It streamlines complex management processes and ensures SIU activities are compliant with regulatory guidelines. Fully scalable, this service is designed to work as a completely outsourced solution or to augment overburdened internal SIU units. Built exclusively for health care, Intelligent Investigator pinpoints patterns of suspicious behavior across all health care claim types, including medical, facility, pharmaceutical and dental. With its easy-to-use interface, Intelligent Investigator effortlessly walks users at all levels through potential fraudulent cases. Taking advantage of the customizable education platform and training offered by LexisNexis, Lovelace completed a two-day program in which Peoples and other key staff members were familiarized with the solutions’ use and capabilities.
Operational Impact
Quantitative Benefit
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