Traditional methods of analyzing healthcare data to identify fraud, waste, and abuse are no longer sufficient to combat increasingly inventive fraudsters who seek to exploit system weaknesses. Health plans need the ability to see how providers, claims, and members are connected not only to one another, but across payers.
Participating attendees will:
- Learn how a multilayered approach can drive the greatest value for your plan; by looking at individuals who are known to be suspicious; by leveraging data mining tools to place effective roadblocks in place prior to program participation; by utilizing predictive modeling to identify likely future offenders.
- Identify key ways to combine and analyze data to provide unparalleled insight into the complex web of relationships, social groups, and potential schemes that put your plan at risk.
- Explore the value of contributory networks and how their use can revolutionize your health plan’s fraud, waste, and abuse efforts.
Director, Market Planning, LexisNexis Risk Solutions
Director, Strategic Solutions, LexisNexis Risk Solutions