Healthcare Fraud Detection and Prevention

Detect and investigate healthcare fraud using a wide variety of data sources and tools

Government-funded healthcare programs represent a substantial investment that has become a big target for fraudulent activity. We have expertise in applying public and proprietary records, open source information, and social media data to address healthcare fraud and abuse, as well as experience in successfully serving relevant large-scale government operations and initiatives.

Healthcare Fraud Detection and Prevention Products


CLEAR is a powerful, intuitive research platform that delivers a vast collection of public and proprietary records on people and businesses, along with associated social media data and news. It includes relevant healthcare industry and key provider content – such as federal and state sanctions, professional licensing information, and National Provider Identifier numbers – and combines it with timely information on criminal history; death records; bankruptcies; judgments and liens; and address, phone, vehicle, and utility records. Through automated analysis of this rich content, CLEAR can pinpoint data aberrations and inconsistencies that may warrant further investigation and support the removal of fraudulent healthcare providers from Medicare and Medicaid payrolls, which can lead to the recovery of billions of dollars in wasteful spending. In fact, CLEAR is relied upon for the most difficult fraud cases in all federal CMS offices, and in approximately half of all state healthcare departments.


Healthcare fraud is a growing business for cross-border criminal enterprises, and World-Check expands screening and investigative capabilities on a global scale, delivering high-quality intelligence on any potential perpetrators. While individuals may appear to have a clean history in the U.S., World-Check can help identify questionable activities overseas that warrant a deeper look. World-Check delivers over three million continuously updated profiles of high-risk individuals and organizations worldwide – including 100 percent of sanctioned entities – and detailed information on politically exposed persons and those who present fraud, trafficking, organized crime, and money-laundering risk.

Enhanced Due Diligence

Thomson Reuters Enhanced Due Diligence reports provide highly customized, deeply researched information on parties of interest that help uncover essential risk information. They offer a cost-effective means of obtaining detailed background and integrity checks to screen and investigate potential perpetrators of healthcare fraud – no matter where they are located in the world.

Fraud Detection and Audit Training Suite

The Thomson Reuters healthcare fraud training suite ensures that legal, accounting, and audit staff know the specifics of detecting and addressing fraud at any stage of the claims workflow, including best practices in preparing documentation for prosecution to maximize penalties within the U.S. legal framework that apply to healthcare fraud.