Investigation ToolBox
Investigation Toolbox
The sharing of information regarding emerging fraud schemes and suspected fraudulent providers between private plans and our government liaison partners or government agencies is a top priority for NHCAA. In order to maintain its position as the number one resource for anti-fraud initiatives, NHCAA consistently reviews and enhances its suite of fraud fighting tools to increase member benefits.
SIRIS®
The Special Investigation Resource and Intelligence System (SIRIS®) hosted by LexisNexis® Risk Solutions is a searchable database comprising three datasets: provider cases, health care fraud schemes, and Requests for Information (RIAs) from law enforcement partners.
Request for Investigation Assistance
RIA provides our Government Liaison agencies the ability to reach scores of private health insurers in one simple step for assistance in their health care fraud investigations.
Information Sharing & Case Discussion (Virtual)
NHCAA offers virtual Information Sharing & Case Discussion events on a monthly basis via a secure platform for our Member Organizations and Government Liaisons.
Information Sharing & Case Discussion (In-Person)
The sharing of case information is one of the cornerstones of NHCAA. Information Sharing & Case Discussion events are offered twice a year in-person.
Fraud Briefs
NHCAA Fraud Briefs are summaries that describe a scheme related to a specific health care service. These summaries can also be used when executive management needs a better understanding of the issue.
Annual Fraud Trends Report
NHCAA’s Annual Fraud Trends Reports highlight key fraud patterns identified by members. Each report features statistical insights and top records by provider type from SIRIS®, along with insights from other NHCAA information-sharing resources.
The Sentinel
The Sentinel is a monthly newsletter that provides members with Anti-Fraud Initiatives’ updates on information-sharing opportunities and resources.
Inside SIRIS®
Inside SIRIS® provides monthly SIRIS® updates specifically designed as a resource for our Member Organizations and Government Liaisons to increase their fraud fighting success.
The Compass
The Compass is a quarterly health care fraud report. It contains intelligence gathered from NHCAA’s Government Liaisons and Member Organizations.
In the Courts
In the Courts is a bi-monthly newsletter that captures and compiles official announcements of health care fraud legal actions from across the country.
