Case Study: Lovelace Health Plan achieves faster fraud detection and significant recoveries with LexisNexis Risk Solutions

Lovelace Health Plan Looks to Make Significant Recoveries From Fraud, Waste and Abuse Activities with LexisNexis® Anti-Fraud Services and Technology

Lovelace Health Plan, an Albuquerque-based insurer serving more than 210,000 members as part of the Lovelace Health System, faced a rising threat of health care fraud and sought a more robust way to maximize detection and recovery of fraudulent, wasteful and abusive claims.

Working with LexisNexis, Lovelace deployed Virtual SIU and the Intelligent Investigator platform and completed focused training for key staff. The tools rapidly uncovered E/M coding outliers and potentially egregious billers, produced fast, customizable reports, supported validation of questionable claims and provider education, and set the team up for significant recoveries—while saving time versus internal data-mining efforts and enabling plans to expand anti‑fraud work into pain management and pharmacy.

Lovelace Health Plan

Paul Peoples

SIU Compliance Officer