Mass. health authority uses ID software to prevent fraud

The Massachusetts Health Insurance Connector Authority is using LexisNexis identity management software to verify the residency information of people participating in the exchange.

The Massachusetts Health Insurance Connector Authority is using LexisNexis identity management software to verify the residency information of people participating in the exchange.

Massachusetts law requires that most residents 18 years of age or older purchase health insurance. Under the contract, LexisNexis will provide residency verification of individuals applying for an unsubsidized Health Connector program – Commonwealth Choice. Specifically, Health Connector will use LexisNexis’ data analytics and linking technology solutions to verify the applicant’s residence.

“All states face the challenge of health care fraud; initiatives such as the Health Connector and other exchanges serve as the front line for secure and efficient access to health care services,” said Clint Fuhrman, director of Government Health Care Programs at LexisNexis.

The Obama administration has stepped up efforts to fight health care fraud, joining forces with private insurers and state investigators to halt the loss of billions of dollars.

Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder on July 26 announced the launch of a ground-breaking partnership among the federal government, state officials, several leading private health insurance organizations, and other health care anti-fraud groups to prevent health care fraud.

The new partnership is designed to share information and best practices in order to improve detection and prevent payment of fraudulent health care billings. Its goal is to reveal and halt scams that cut across a number of public and private payers.

One innovative objective of the partnership is to share information on specific schemes, utilized billing codes and geographical fraud hotspots so that action can be taken to prevent losses to both government and private health plans before they occur, administration officials said. 

A potential long-range goal of the partnership is to use sophisticated technology and analytics on industry-wide health care data to predict and detect health care fraud schemes.

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