Thomson Reuters introduces CLEAR for Healthcare Fraud

CLEAR, the powerful public and proprietary records service and investigative suite from Thomson Reuters, is well-regarded among law enforcement and government investigative professionals for helping nab criminals and recover missing children. Today, the business is introducing a new version of the service to aid in the recovery of the $60 billion that the National Health Care Anti-Fraud Association estimates is lost each year to fraud.

CLEAR for Healthcare Fraud takes specific industry data and key provider content such as NPI (National Provider Identifier) numbers, sanctions data and professional licensing information, and combines it with a deep collection of utility records, cell phone data and other public records, to provide a powerful search tool that can pinpoint not just minor data aberrations, but true inconsistencies warranting further investigation. The results of those investigations can help remove fraudulent healthcare providers from Medicare and Medicaid payrolls and recover billions of dollars in wasteful spending.

CLEAR for Healthcare Fraud offers the fraud, waste and abuse detection market its most comprehensive solution to date, including more live gateways to real-time data as well as Web analytics that combine public records data with Web search capabilities.

"We are uniquely positioned to combine market expertise and unique content sets from across Thomson Reuters to provide our customers with a new level of power in the healthcare fraud, waste and abuse mitigation space," said Jim Smith, CEO of the Professional division of Thomson Reuters.

The power of CLEAR for Healthcare Fraud has already been realized by the program integrity unit of one state Medicaid office. A rogue physician, wanted on several counts of Medicaid fraud, was evading capture until a search using CLEAR for Healthcare Fraud's Web Analytics feature uncovered an Internet post that indicated he was speaking at a medical conference overseas. The information was passed on to law enforcement for arrest and prosecution.

"This new service builds on recent implementations of CLEAR in our fraud detection solutions for the government market," said David Nelson, director of strategy and market planning for the company's state and federal government markets. "We currently work with almost half of all state Medicaid agencies to fight fraud, and our customers across the healthcare spectrum – including large employers and health plans – have expressed a desire for more comprehensive fraud solutions, including the information available through CLEAR."

Here are a few more examples of the kinds of results CLEAR for Healthcare Fraud can deliver:

• A medical transportation company reports a suspiciously high number of transports. A search in CLEAR's records turns up only two vehicle registrations for that company, prompting an investigation.
• A fraudulent medical provider moves to a new state under a new name to avoid being caught. But she signs up for utility service under her real name. An investigator searching in CLEAR for Healthcare Fraud – which includes utility records data – finds her, and she is arrested by local law enforcement officials.

"Containing and controlling the cost of healthcare is one of the foremost challenges facing public policy and private enterprise, and that will continue into the future. CLEAR for Healthcare Fraud can play a key role, not just in detecting fraud, waste and abuse, but also in preventing it," said Stephen Rubley, vice president and general manager of Thomson Reuters Risk, Fraud and Investigations business.