LexisNexis to Host New Fraud Fighting Tool for NHCAA Members

Business Wire, Nov 4, 2005

WASHINGTON & BOCA RATON, Fla. -- LexisNexis(R), a leading provider of legal, news, business information and risk management services, announced today that corporate insurer members of the National Health Care Anti-Fraud Association (NHCAA), as well as law enforcement and regulatory agencies, will benefit from advanced information and data access technology provided by LexisNexis, as a public service to the health care insurance industry. The advanced information and data access technology is called Special Investigation Resource and Intelligence System (SIRIS), which is a robust, easy-to-use computerized information-sharing system used to track and identify potentially fraudulent health care cases. The system went live yesterday.

"LexisNexis is dedicated to serving the health care industry and consumers by creating solutions to combat health care fraud," said John Benson, vice president of health care solutions for LexisNexis risk management business unit. "That is why we are proud to have this strategic alliance with the NHCAA to create industry-leading solutions for our customers and corporate insurer members."

NHCAA SIRIS demonstrations will be held Nov. 8-9, 2005, at the NHCAA 2005 Annual Training Conference held in San Diego, California. The conference is sponsored by the NHCAA Institute for Health Care Fraud Prevention whose goal is to protect the public interest by providing unparalleled professional education and training to private and public sector persons responsible for the prevention, detection, investigation and prosecution of health care fraud. For those unable to attend, LexisNexis and NHCAA will provide training on-line. LexisNexis is a long-standing Premier Sponsor of the NHCAA Institute.

"I can't think of a better example of an alliance in action between the public and private sectors in combating health care fraud ... it's right out of our Mission Statement," stated Louis Saccoccio, executive director, NHCAA.

SIRIS Defined

NHCAA insurer members will now be able to share critical information regarding potentially fraudulent health cases far easier than any information technology heretofore available. Moreover, the data is rich with useful descriptions of health care fraud schemes, patterns, investigations and trends; all of which can be shared with a variety of law enforcement agencies for reporting suspected fraudulent activities and ultimately prosecuting those responsible.

Enhanced to be more user friendly, SIRIS provides improved navigational features and more robust search capabilities. Additional features to be implemented in the immediate future include data and report expansion and improved state reporting.

SIRIS Aggregations Plus LexisNexis(R) Data Sets

Each corporate insurer member may enter its case information including the nature and evidence of suspected fraud. Participants who are also LexisNexis users will have access to public records data sets and link analysis tools. When combined with information about suspected fraud, these investigation resources and tools can drive action and prosecution of insurance fraud, both criminal and civil.

Criminal Justice System Inclusion

Operating as a triangle of mutuality, this data repository and information-sharing effort also encourages and allows access by criminal justice agencies such as the Federal Bureau of Investigation (FBI), the Department of Health and Human Services, Office of Inspector General (HHS-OIG), Centers for Medicare & Medicaid Services (CMS), Defense Criminal Investigative Service (DCIS), Internal Revenue Services (IRS) and some state fraud bureaus.

$51 Billion Issue

Viewed as a serious, nationwide crime phenomenon, health care fraud is estimated to cost 3% or $51 billion of America's $1.7 trillion annual health care cost. Health care spending in the U.S. is five times that of defense and three times that of education. Health care insurers, Medicare and Medicaid and consumers bear the cost of fraud which represents an ever growing burden in the form of increased premiums, taxes, co-pays and deductibles.

About NHCAA

Founded 20 years ago by several private health insurers and federal and state law enforcement officials, NHCAA is a unique issues-based non-profit organization comprised of private and public sector organizations and individuals who combat fraud in the nation's health care system. NHCAA's mission is to serve and protect the public interest by increasing awareness and improving the detection, investigation, prevention and civil and criminal prosecution of health care fraud.

NHCAA pursues its mission by maintaining a strong private-public partnership and information sharing capabilities, providing unparalleled learning and training opportunities through the NHCAA Institute , recognizing professional specialization through accreditation and by serving as a resource to government, industry and the media. For information regarding NHCAA Corporate membership and benefits, please contact Leigh McKenna, Director of Member Services, lmckenna@nhcaa.org.