Cross – industry fraud – where healthcare fraud, property/casualty and workers’ compensation fraud intersect – is the next step in identifying potentially bad providers. LexisNexis completed a study that revealed an overlap between providers who commit fraud on the healthcare side and those who do it on the property/casualty side. In addition, there was a greater probability that those providers would be involved in identity theft, tax evasion as well as other criminal activity.

“There was about a 22 percent overlap of seeing the same doctors generally practicing on both the healthcare side and the auto side,” says Todd Fannin, director of claims for LexisNexis Risk Solutions. “Within that data set, about four percent of those had been identified as being potentially bad providers by either property/casualty or healthcare insurers.”

Additional studies seeking to determine the prevalence of cross-industry fraud across the insurance, credit, financial and wider private industry markets have demonstrated how a collaborative approach between industry members can shine a light on previously hidden fraud patterns. In a recent LexisNexis Risk Solutions survey of fraud mitigation professionals, 84 percent of respondents from insurance, health care, government, financial services, communications and retail indicated that they are seeing at least some cross-industry evidence in fraud cases they investigate, and more than three quarters indicated that the impact of fraud that was linked to other industries had a moderate to extremely high financial impact on their organization.

Traditional data analytics tools are limited in that they have focused primarily on data sets that are too narrow. There is therefore a need for fraud mitigation professionals to expand their field of vision. Such an initiative helps organizations detect and intercept fraud before it happens, to safeguard from losses due to fraud. This is significant because traditional “pay-and-chase” models that prioritize recovery over prevention have been exposed as overly costly and less effective than advanced “prevention-based” models that attempt to stop the fraud before it occurs.

The National Health Care Anti-Fraud Association (NHCAA) sponsors the Special Investigation Resource and Intelligence System (SIRIS), where members share information regarding fraud cases they have encountered for the purpose of helping to mitigate fraud elsewhere. The Association was founded in 1985 by several private health insurers and federal and state government officials. It is focused exclusively on the fight against health care fraud. As a private-public partnership – members comprise more than 100 private health insurers and those public-sector law enforcement and regulatory agencies having jurisdiction over health care fraud committed against both private payers and public programs. One mission is serving as a national resource for health care anti-fraud information and professional assistance to government, industry and media.