Lovelace Health Plan Looks to Make Significant Recoveries From Fraud, Waste and Abuse Activities with LexisNexis® Anti-Fraud Services and Technology
公司规模
1,000+
地区
- America
国家
- United States
产品
- Virtual SIU
- Intelligent Investigator
技术栈
- Advanced Fraud Detection System
- Customizable Education Platform
实施规模
- Enterprise-wide Deployment
影响指标
- Cost Savings
- Customer Satisfaction
- Productivity Improvements
技术
- 分析与建模 - 预测分析
- 应用基础设施与中间件 - 数据交换与集成
- 功能应用 - 企业资源规划系统 (ERP)
适用行业
- 医疗保健和医院
适用功能
- 商业运营
- 质量保证
用例
- 欺诈识别
- 监管合规监控
- 远程资产管理
服务
- 系统集成
- 培训
关于客户
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.
挑战
To meet the rising threat of health care fraud, Lovelace sought a robust solution to maximize its detection abilities.
解决方案
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.
运营影响
数量效益
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