ATLANTA, Nov. 14, 2016 /PRNewswire/ -- Through the National Health Care Anti-Fraud Association (NHCAA) database SIRIS(Special Investigative Resource and Intelligence System), hosted by LexisNexis® Risk Solutions, NHCAA brings insights to the market on how to curb health care provider fraud. Now, the results of a joint research study between LexisNexis Health Care and the NHCAA provide a new vantage point from which NHCAA members can view potential fraud, waste and abuse (FWA). The study results will be announced at the NHCAA Anti-Fraud Expo, November 15-17, Atlanta, GA.
SIRIS is a contributory database that allows NHCAA members to submit, track, monitor and share information related to potential provider fraud and associated investigations. The new research study assessed the value of adding external provider derogatory data to SIRIS and determined the following:
Incorporation of external derogatory provider data into SIRIS can expose providers that possess strong indicators of fraud.
Fraud data from different industries can provide alerts of potential fraud earlier than data from within a single market.
"The key learning from the study was that incorporating public records such as bankruptcies, liens and judgements, medical license expirations and criminal records all can shine additional light on health care fraud," said Cynthia Lucas, Senior Director of Anti-Fraud Initiatives, NHCAA. "When we add the ability to leverage interest across multiple industries to identify suspicious subjects, we become much better equipped to catch newer, more sophisticated fraud schemes. Our joint research study with LexisNexis Health Care reveals new ways to determine activities and signals that are highly predictive of fraud and enable our members to address potential fraud earlier." Specifically for the study, SIRIS providers were analyzed using LexisNexis Health Care data and analytics to see what derogatory data was returned and if that data applied to the SIRIS records in a meaningful way. LexisNexis Health Care applied three additional layers of data in the study: