Tracks & Sessions

Select sessions from one of the seven education tracks, or pick and choose across tracks to create the optimal program for your professional development needs. Programs are assigned one of three levels:

Level I
Basic programs where little or no investigative, health care and/or IT expertise is expected, terms and acronyms are defined, concepts are explained in greater detail, and the education focus is on investigative skills.

Level II
Programs where some investigative, health care and/or coding expertise is assumed and training content is focused on the investigative process, using case examples to highlight investigative strategy and techniques.

Level III
Training designed to meet the needs of health care fraud senior investigators and managers, with a focus on synthesizing ideas and exploring strategies, concepts and information needed to direct a health care fraud investigative unit.

Note, audio and/or video recordings of NHCAA's Annual Training Conference sessions, general or break-out, are not allowed.

Clinical Understanding for Health Care Investigators
Workshops with a focus on the furthering better clinical understanding within investigative work.
  • Clinical Modalities & SubspecialtiesMgmt Path
    Wednesday, 9:15 a.m. - 10:30 a.m.
    Level III

    John S. Yao, MD, MPH, MBA, MPA, FACP
    Senior Medical Director, Blue Shield of California

    Join an in-depth examination of inappropriate billing of diagnostic procedures and clinical modalities in professional claims across medical and surgical specialties. Understand fraud and abuse of various medical technologies and procedures, and misuse of specific CPT and HCPCs codes.

  • AHFI PathSpecial Considerations for Fraud, Waste and Abuse at the Medical-Behavioral Interface
    Wednesday, 11:00 a.m. - 12:00 p.m.
    Level II

    Karen Dodd, MSW, LCSW, MBA
    Director of Clinical Operations, OptumHealth Behavioral Solutions

    Patricia Lefort
    Manager, SIU, OptumHealth Behavioral Solutions

    James M. Slayton, MD, MBA
    National Medical Director, OptumHealth Behavioral Solutions

    Faculty highlights FWA concerns related to neuropsychological testing, autism-related services, home health and nursing home services, in light of recent Federal Mental Health Parity mandates. Explore unique patterns and management challenges specific to behavioral health investigations, through examples of claims analysis, data mining, clinical case review, investigation and red flags.

  • Fraud in the Treatment of Varicose Veins (R)
    Wednesday, 2:00 p.m. - 3:00 p.m. | Thursday, 2:40 p.m. - 3:40 p.m.
    Level II

    James Moss, MD, FACS
    Medical Director, Special Investigations Unit, Humana

    Health care fraud in the management of varicose veins is widespread and growing, as newer treatment methods have evolved while evaluation of management has relied on largely subjective criteria from the past. With newer treatments have come new diagnostic modalities which enable us to review management in a more objective manner. Faculty will provide a basis for understanding these new options and focus on strategies to detect and prevent fraud.

  • Office-Based and Surgical ENT Procedures
    Thursday, 8:45 a.m. - 10:00 a.m.
    Level II

    Fred Holt, MD, JD, AHFI
    Medical Director, Blue Cross Blue Shield of North Carolina

    Denis O'Connell, MD, MPA
    Medical Director, Consultant to the SIU, Blue Cross Blue Shield of North Carolina

    Experts demonstrate appropriate use, documentation, coding, and evidence-based guidelines for a variety of ENT surgical and office-based procedures including endoscopic sinus surgery and nasal endoscopies. Attendees will glean information on ways to identify the components in the medical record needed to support claims, and how to test claims data for cost trends.

  • Medical Directors Quick Hits Panel AHFI Path
    Thursday, 10:45 a.m. - 12:00 p.m.
    Level II

    David J. Falk, MD
    Medical Director, OptumInsight

    Thomas Hawkins, MD
    Medical Director, Blue Cross Blue Shield of Massachusetts

    Edward N. Hunsinger, MD
    National Medical Executive, Fraud Waste & Abuse, Cigna

    Medical Directors from NHCAA Member Organization present a series of clinical red flags from a variety of specialty areas, and offer suggestions on how to investigate medical claims in future investigations. The physicians will share clinical questions from the SIUs they support, and respond to participant inquiries.

  • The Pain Management Practice (R) AHFI Path
    Thursday, 1:30 p.m. - 2:30 p.m. | Thursday, 4:00 p.m. - 5:00 p.m.
    Level II

    Ayms Lang, MD, AHFI
    Senior Investigator, WellPoint, Inc.

    Examine myriad fraud schemes in the pain management practice involving physical therapy, vasopneumatic therapy EMGs and nerve conduction studies and autonomic nervous system testing. Cases examples will be used to illustrate investigative techniques and appropriate coding and documentation.

Detecting Dental Fraud Track
Identify new strategies for detecting and preventing dental fraud schemes.
  • Dual Eligibility & Dental Fraud
    Wednesday, 9:15 a.m. - 10:30 a.m.
    Level II

    Stewart Balikov, DDS
    National Dental Director Utilization Management, Aetna

    Richard Celko, DDS, AHFI
    Regional Dental Director, Avesis

    Commercial and non-commercial dental plans have similarities and differences between them that present both common and unique opportunities for fraud and abuse. These opportunities can significantly increase where Medicaid and Medicare duel eligibility of coverage exists. Examples from a variety of dental areas, including general anesthesia, orthodontics and restorative dentistry will be presented to illustrate the opportunities for fraud and abuse in commercial and non-commercial plans.

  • Identifying Abuse of Dental Codes AHFI Path
    Wednesday, 3:10 p.m. - 4:10 p.m.
    Level II

    Kim Brown RDH
    Clinical Fraud Analyst, Delta Dental of Virginia

    Trish Shifflett, RDH
    Clinical Fraud Analyst, Delta Dental of Virginia

    Investigation, proof of analysis and presentation of the results for the abuse of codes is a far more difficult and challenging task than an obvious cases of fraud. Abuse involves patterns of overutilization or upcoding that negatively impacts insurers and enrollees. Faculty will provides details on a variety of CDT codes most frequently abused and how to detect patterns and red flags. A demonstration of a case presentation to a suspect provider will illustrate how to substantiate a case using well documented and defensive evidence.

  • Understanding Dental Anesthesia (R)
    Thursday 8:45 a.m. - 10:00 a.m. | Friday, 9:45 a.m. - 11:00 a.m.
    Level II

    Richard Celko, DDS, AHFI
    Regional Dental Director, Avesis

    George Koumaras, DDS
    Dental Director, Delta Dental of Virginia

    Dental experts provide a deeper understanding of the component parts of dental anesthesia records, the typical drugs used, the criteria for determination if anesthesia is necessary and how to distinguish between general anesthesia and conscious sedation. Claim examples that demonstrate misrepresentation of fact and alleged fraud highlight how to interpret anesthesia records to identify abusive and fraudulent submissions. Walk away with tips related to appropriate surgical time and billing.

  • Mobile Dental Units: A Case Study AHFI Path
    Thursday, 2:40 p.m. - 3:40 p.m.
    Level II

    Robert Banter, AHFI, CFE
    Auditor, Indiana Medicaid Fraud Control Unit

    Sheila Green
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    The case centers on mobile dental units targeting low income housing, head start programs, mental health group homes and elementary schools. The units did not have running water, properly qualified personnel, or safety and quality protocols. The investigators will demonstrate a variety of fraud schemes used to perpetrate the crimes, and the data analysis and investigative skills used to build the evidence for conviction.

  • Dental Quality of Care: The Paper Clip Case
    Thursday, 4:00 p.m. - 5:00 p.m.
    Level II

    Toby Unger
    Assistant Attorney General, Commonwealth of Massachusetts, Office of the Attorney General

    Gregory Zachos
    Assistant Attorney General, Commonwealth of Massachusetts, Office of the Attorney General

    Through examples from trial, explore a detailed case study of a high profile dental case involving a Massachusetts dentist defrauding the Medicaid program and practicing sub-standard care, including the use of paper clips for root canals, in place of stainless steel posts.

Fraud Investigations in Specialty Areas Track
Follow investigations that uncover new trends and schemes within the industry.
  • Law Enforcement Panel: Pharmacy LEL Path AHFI Path
    Wednesday, 9:15 a.m. - 10:30 a.m.
    Level II

    Michael Cohen
    Inspector, U.S. Department of Health & Human Services, OIG-OI

    James D. Durham
    First Assistant United States Attorney, Southern District of Georgia

    Keith Hadley
    Special Agent, U.S. Food and Drug Administration, Office of Criminal Investigations

    James R. Rogers
    Supervisory Special Agent, U.S. Department of Justice, Federal Bureau of Investigation

    A multi-agency panel discusses government fraud and abuse efforts in the pharmaceutical industry. Through case examples, participants will examine a broad array of recent pharmaceutical fraud cases and emerging trends.

  • Comprehensive Outpatient Rehabilitation Facilities: Emerging Fraud Trends (R) LEL Path
    Wednesday, 9:15 a.m. - 10:30 a.m. | Thursday, 2:40 p.m. - 3:40 p.m.
    Level II

    Stephen Quindoza
    Medicare Operations Coordinator, Zone 7 Program Contractor, IntegriGaurd

    Rafael Chocron
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    The growth of Comprehensive Outpatient Rehabilitation Facilities (CORFs), non-residential facilities that provide diagnostic, therapeutic, and restorative services under the supervision of physicians, has been exponential. Faculty will explain the regulatory policies surrounding CORFs, how they operate, and their relation to emerging fraud trends in Florida. Hear portions of a current investigation in the Middle District of Florida regarding a network of CORFs throughout the state that are established for the sole purpose of billing for services not rendered.

  • Investigational Alternative Medicine Therapies (R)
    Wednesday, 11:00 a.m. - 12:00 p.m. | Thursday, 2:40 p.m. - 3:40 p.m.
    Level II

    Kathleen Shaker, RN, BSN, AHFI, CPC, CPC-H
    Investigative Consultant, BlueCross BlueShield Association

    Diana Chastain, RN, LNC, AHFI, CPC
    Investigative Consultant, BlueCross BlueShield Association

    "New age" or alternative medicine treatments are often considered investigational by health payers; however, they are slipping through the claims systems undetected. During the presentation, attendees will learn about chelation, intravenous vitamin and mineral therapy infusions and adjunctive acupuncture treatments including cupping and moxibustion with mug wort. The investigational lab services (using blood, saliva, hair) performed in conjunction with the therapies will be reviewed and affiliated procedure codes provided.

  • The Federal Anti-Kickback Statute: a Case Analysis and Investigative Overview LEL PathSession Cancelled
    Wednesday, 11:00 a.m. - 12:00 p.m.
    Level II

    Eric Rubenstein
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    Review the elements of the Federal Anti-Kickback statute and understand the unique aspects of the investigative process for these types of violations. Examine current case models involving a large scale kickback scheme where dozens of medical providers were paid cash in return for the referral of patients in need of radiological services. Through the use of an analysis of the investigation, including covert video, participants will learn the necessary steps required to create an airtight prosecution into such allegations.

  • Ophthalmology Fraud AHFI Path
    Wednesday, 2:00 p.m. - 3:00 p.m.
    Level II

    Carrie Ward, AHFI, CFE
    Vice President of Operations, Medi-Medi Project Director, Health Integrity, LLC

    Highlights of a current investigation provide the foundation to explore problematic ophthalmology and optometry tests and procedure codes. Understand the use of procedure codes in data analysis to uncover possible fraudulent or abusive schemes in both Medicare and Medicaid programs.

  • Fraud in the Retail Pharmacy LEL Path
    Wednesday, 2:00 p.m. - 3:00 p.m.
    Level II

    Jason Bell
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    Jeffrey Davis
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    Focus on current and emerging fraud trends in the retail pharmacy industry. Investigative examples provide strategies to detect fraudulent behavior. Faculty examines the usefulness of claims analysis to uncover schemes.

  • 2012 Investigation of the Year
    Wednesday, 3:10 p.m. - 4:10 p.m.
    Level II

    Welcome the recipients of NHCAA's 2012 Investigation of the Year Award and listen to the investigative strategies, multi-organization cooperation and case-building excellence that led to a successful resolution, as well as to the coveted NHCAA honor.

  • Platelet Rich Plasma (PRP) Miscoding (R)
    Wednesday, 3:10 p.m. - 4:10 p.m. | Thursday, 4:00 p.m. - 5:00 p.m.
    Level II

    George M. Koumaras, DDS
    Dental Director, Delta Dental of Virginia

    Howard Levinson, DC, AHFI, CFE, CPC
    Clinical Investigator, WellPoint, Inc.

    An increase in the number of providers, including sports medicine, dentists and podiatrists, utilizing PRP in their practices has been observed. PRP by injection or topical gel, is used to promote the healing process of injuries. PRP injection therapy is listed as investigational by most payers, including Medicare. PRP was issued a HCPCS code as of July 2010 (0232T) which includes the incidental services such as ultrasound guidance (CPT 76942) and injections (CPT 2055X) that are frequently unbundled and submitted. After attending this session, attendees will be able to data mine, identify PRP by claims, see images of the procedure and equipment and learn a strategy for both identifying intent and recovering fraudulent or abusive claims.

  • Law Enforcement Panel: Medical Identification Theft LEL Path
    Thursday, 8:45 a.m. - 10:00 a.m.
    Level II

    Andrew McKee
    Inspector, Investigations Branch, U.S. Department of Health & Human Services, OIG-OI

    Cathleen Connolly
    Special Agent, U.S. Department of Justice, Federal Bureau of Investigation

    Jean M. Stone
    Program Integrity Senior Specialist, U.S. Department of Health & Human Services, CMS

    Examine the theft of provider and payer identities, with a focus on high profile HIPAA violations, large medical identify theft rings, and the involvement of criminal organized crime. Hear current prevention and enforcement efforts from multiple law enforcement and integrity agencies.

  • Law Enforcement Panel: Durable Medical Equipment (DME) LEL Path AHFI Path
    Thursday, 8:45 a.m. -10:00 a.m.
    Level II

    Mark Coleman
    Special Agent, U.S. Department of Justice, Federal Bureau of Investigation

    Jack J. Geren, Jr.
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    Joseph Martin
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    Law enforcement agents provide a nationwide perspective on myriad DME schemes across the country.

  • Structured Criminal Activity & Health Care Fraud LEL Path
    Thursday, 10:45 a.m. - 12:00 p.m.
    Level II

    John F. Campanella
    Supervisory Special Agent, U.S. Department of Justice, Federal Bureau of Investigation

    Jennifer Trussell
    Special Agent in Charge, Investigations Branch, U.S. Department of Health & Human Services, OIG-OI

    Law enforcement provides an in-depth look at organized crime structure, syndicate activity, and a variety of schemes and players in various geographical regions across the U.S.

  • Podiatry Procedures Codes (R) AHFI Path
    Thursday, 10:45 a.m. - 12:00 p.m. | Friday, 9:45 a.m. - 11:00 a.m.

    Paul Kinberg, DPM
    Podiatrist

    Faculty provides a comprehensive overview of podiatry procedures that are frequently abused by unscrupulous podiatrists and procedures that are misunderstood by investigators. Examine the procedure, the medical necessity and coverage under most insurance, correct documentation and procedure codes. Walk away understanding red flags to aid in detection.

  • Allergy & Immunotherapy Coding Red Flags (R)
    Thursday, 1:30 p.m. - 2:30 p.m. | Thursday, 4:00 p.m. - 5:00 p.m.
    Level II

    Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC
    President, CRN Healthcare Solutions

    Expert faculty examines various types of allergy testing, medical professionals who can perform testing, and what supporting documentation is required. Understand the different levels of allergen testing, supervision requirements and documentation necessary in the medical record in order to submit codes for reimbursement.

  • Hospital Part A, Outpatient Billing Fraud, a Case Study AHFI Path LEL Path
    Thursday, 2:40 p.m. - 3:40 p.m.
    Level II

    Charles O. Thomas, LPN
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    Through a complex case study example, examine the detection and investigative process that uncovered outpatient billing schemes including: outpatient visits for elective interventional cardiac procedures, elective surgeries, and observation visits post emergency room treatment billed as inpatient visits.

  • The "$30M Ortho Kit Scheme" LEL Path
    Thursday, 2:40 p.m. - 3:40 p.m.
    Level II

    Jack J. Geren, Jr.
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    Joseph Martin
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    Examine a scheme hatched by the creative criminal mind of one individual, resulting in an excess of $30M paid by the Medicare Program for braces and orthotic devices that are typically found in convenience stores at a much lower price. This presentation will combine analytics and humor with the presentation of a nationwide DME case that ultimately led to the conviction of over a dozen individuals spanning several judicial districts. In this session, you will learn how the scheme was uncovered by law enforcement, how constant communication and organization were instrumental in bringing those responsible to justice and how future edits can prevent the pervasiveness of this scheme.

  • Ambulance Fraud: A Case Example LEL Path
    Thursday, 4:00 p.m. - 5:00 p.m.
    Level II

    Charles Kincaid
    Special Agent, U.S. Department of Justice, Federal Bureau of Investigation

    Joshua Gill
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    Examine the medical necessity of ambulance transportation and its abuse by companies specifically dealing with the transport of dialysis patients to and from treatment. Through a case example, understand the unique aspects of transportation fraud investigations, and the involvement of criminal elements. Hear encouraging government policy changes that have the potential to help CMS contractors combating the abuse.

  • The Maxim Healthcare Fraud and the False Claims Act LEL Path
    Thursday, 4:00 p.m. - 5:00 p.m.
    Level II

    Michael J. Maggipinto
    Special Agent, U.S. Department of Justice, Federal Bureau of Investigation

    Gene Fayer
    Special Agent, US Department of Health and Human Services, OIG-OI

    Jacob T. Elberg
    Assistant United States Attorney, U.S Attorney's Office, District of New Jersey

    Gerard Poto
    Special Agent, Department of Veterans Affairs, Northeast Field Office

    In 2011, the Department of Justice announced the largest resolution ever in a home healthcare case, recovering $150 million, convicting nine individuals of felonies, and entering into a Deferred Prosecution Agreement with Maxim Healthcare Services, Inc. The lead prosecutor and Special Agents from the case will discuss the nation-wide investigation and global resolution of this matter.

Investigative Toolbox Track
Education supplying both novice and experienced investigators practical tools and techniques to use in today's investigations.
  • Using Social Networks in Investigations Mgmt Path
    Wednesday, 9:15 a.m. - 10:30 a.m.
    Level III

    Roy A. Mura, Esq.
    Mura & Storm, PLLC

    Explore techniques for finding information on social networking sites, as well as validating the use of the information discovered. Understand the evolving legal environment and how to manage legal risk when using social media in fraud investigations.

  • The Onsite Audit: The Basics
    Wednesday, 11:00 a.m. - 12:00 p.m.
    Level I

    Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI
    Senior Investigator, Blue Shield of California

    Add onsite audits to your arsenal of investigative tools. Learn how to identify candidates, prepare files to audit, equipment and staffing needs and how to successfully write a comprehensive audit findings report.

  • Medical Record Review: Panel Discussion Mgmt Path
    Wednesday, 2:00 p.m. - 3:00 p.m.
    Level III

    Richard R. Balsamo, MD, JD
    Medical Director, Clinical Investigation, WellPoint, Inc.

    Christopher J. Ferrara, AHFI
    Supervisor, Financial Investigations Department, Medical Mutual of Ohio

    David J. Sand, MD, MBA, FACS, CHCQM
    Chief Medical Officer, CarePoint Advantage

    Effective communication is essential to the success of the medical review process. Discuss how to prepare for a medical record review, provide information that is most useful to the medical director or outside reviewer, and how to avoid the "battle of the experts."

  • Following the Money: Financial Crimes Enforcement Network (FinCEN) LEL Path
    Wednesday 3:10 p.m. - 4:10 p.m.
    Level II

    Warren Danzenbaker
    Lead Senior Analyst on FinCEN's Health Care Fraud Initiative, Senior Intelligence Research Specialist Financial Crimes Enforcement Network (FinCEN)

    Hear a new tool to broaden the scope of law enforcement investigations through the use of the Financial Crimes Enforcement Network (FinCEN). Understand how FinCEN can provide analytical case support on cases where there are numerous Bank Secrecy Act (BSA) filings and the value of following the money in any health care fraud investigation. Faculty provides examples of FinCEN's successful partnering with the HHS-OIG in support of their largest health care fraud investigations.

  • Predictive Modeling Panel Mgmt Path
    Wednesday, 3:10 p.m. - 4:10 p.m.
    Level III

    David Botsko, PhD, CFE
    Managing Principal - Healthcare, Verizon

    Ross Kaplan
    Solutions Architect for Health Care Fraud, Fraud and Financial Crimes Global Practice, SAS

    James V. McCall, AHFI
    Solutions Consultant, IBM

    Moderator: Ralph J. Carpenter
    Director, Special Investigation Unit, Aetna

    Building predictive models to uncover health care fraud is a complex undertaking. Challenges include: the sensitivity to false positives, ever-changing thresholds when more sophisticated fraudsters adapt their strategies, high sensitivity to false positives, and the difficulty applying models to an in-exact science. In this session, data mining and modeling experts share both experiences and success.

  • Preparing an Investigation from Allegation to Prosecution (R) AHFI Path
    Thursday, 8:45 a.m. - 10:00 a.m. | Friday, 9:45 a.m. - 11:00 a.m.
    Level I

    Joe Dixon
    Deputy General Counsel for Government and Internal Investigations, UnitedHealth Group

    Richard E. Munson, AHFI
    VP, Investigations, UnitedHealthcare Government Programs

    This session will provide a comprehensive overview of how to prepare a strategy for developing a case. Using an oncology case example, faculty begins with the assessment of the initial allegation(s) and will walk the investigator through development of a comprehensive investigative plan, execution of the investigation, preparation and completion of an investigative report, culminating with the presentation of the investigation to law enforcement.

  • Identify & Investigate Medicare Part D Diversion CasesLEL Path
    Thursday, 8:45 a.m. - 10:00 a.m.
    Level II

    Robb Breeden
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    Brandy Colfesco
    Assistant Special Agent in Charge, U.S. Department of Health & Human Services, OIG-OI

    OIG and DEA undercover agents and supervisor will share experience, tips, and best practices on how to identify, generate, and effectively work drug diversion cases involving the Medicare PartD program and private insurers. Particular attention will be given on how to identify Medicare PartD/private insurer tie-in, how to conduct undercover operations in order to quickly identify suspect providers, and how to institute community/pharmacy outreach as a way to identify and generate leads.

  • Using Analytic Tools in a Real Case - Link Analysis Software
    Thursday, 1:30 p.m. - 2:30 p.m.
    Level II

    Aneta Andros, AHFI
    Senior Fraud Specialist, Cigna

    Tom Hixson
    Audit Director, Cigna

    Today's investigations are becoming increasingly complex with sophisticated schemes and enormous amounts of data from disparate sources. The key is to identify a method to analyze the data so that it drives an investigation in the right direction. Using a patient brokering scheme as an example, faculty will outline the scheme and provide a method of analysis using resources including background reports and link analysis tools. Learn how to utilize the data analysis findings to identify key players, relevant timeframes and prepare for patient interviews as well as use the analysis for law enforcement presentations.

  • Summary Evidence in Health Care Fraud Prosecutions LEL Path
    Thursday, 2:40 p.m. - 3:40 p.m.
    Level II

    Benjamin Singer
    Assistant Chief, Fraud Section, U.S. Department of Justice, Criminal Division, Fraud Section

    Justin M. Shammot
    Supervisory Special Agent, U.S. Department of Justice, Federal Bureau of Investigation

    Understand the use of summary charts and exhibits in the preparation and presentation of voluminous evidence, including Medicare billing data, bank records, and patient files. Faculty explains how to convey voluminous and complex evidence that are typical in health care fraud prosecutions in a way that courts and juries can understand.

  • Search Warrants in Investigations LEL Path
    Thursday, 4:00 p.m. - 5:00 p.m.
    Level II

    Joseph Beemsterboer
    Senior Trial Attorney, U.S. Department of Justice

    Ben Curtis
    Assistant Chief, U.S. Department of Justice, Criminal Division, Fraud Section

    The federal government has increased the use of search warrants as a tool for health care fraud investigations. Faculty will demonstrate, through case examples, appropriate and successful use of search warrants and strategies for preparation, writing and presentation.

Legal, Management & Regulatory Track
For the SIU manager, workshops on today's legal and regulatory trends, public sector fraud case studies, and sessions on management of the SIU.
  • CMS Program Integrity Update
    Wednesday, 9:15 a.m. - 10:30 a.m.
    Level II

    Peter P. Budetti, MD, JD
    Deputy Administrator and Director, Center for Program Integrity, U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services

    From the Director of the Center for Program Integrity, hear recent health care fraud detection and prevention initiatives, fraud detection technology advances and enhanced fraud initiatives under the Patient Protection and Affordable Care Act.

  • Healthcare Fraud Prevention Partnership PanelMgmt Path
    Wednesday, 11:00 a.m. - 12:00 p.m.
    Level III

    Louis Saccoccio
    CEO, National Health Care Anti-Fraud Association

    Ted Doolittle
    Deputy Director, Center for Program Integrity, U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services

    Jennifer Trussell
    Special Agent in Charge, Investigations Branch, U.S. Department of Health & Human Services, OIG-OI

    Gerald W. Wilson
    Chief, Health Care Fraud Unit, U,S. Department of Justice, Federal Bureau of Investigation

    Join industry leaders as they discuss the Healthcare Fraud Prevention Partnership (HFPP) Panel, a new initiative to bring together the resources and best practices of the government and private sector to more effectively detect and prevent fraud. Panelists will explain the partnership's strategy to advance fraud prevention through enhanced information sharing.

  • Dual Prosecution of Health Care Fraud Cases LEL Path
    Wednesday 11:00 a.m. - 12:00 p.m.Mgmt Path
    Level III

    John Neal
    Assistant United States Attorney, United States Attorney's Office, Eastern District of Michigan

    William Pericak
    Assistant Chief, U.S. Department of Justice, Criminal Division, Fraud Section

    Prosecutors discuss the benefits of pursuing both criminal and civil remedies, and specific evidence gathering techniques that assist in successful prosecution. Case examples illuminate the decision-making process and dual prosecution strategies.

  • Health Care Fraud Strike Force, 2012 and Beyond LEL Path
    Wednesday, 2:00 p.m. - 3:00 p.m.
    Level II

    Sam S. Sheldon
    Deputy Chief, U.S. Department of Justice, Criminal Division, Fraud Section

    Benjamin Singer
    Assistant Chief, Fraud Section, U.S. Department of Justice, Criminal Division, Fraud Section

    Prosecutors provide an update on how the U.S. Department of Justice, Federal Bureau of Investigation and the U.S. Department of Health & Human Services Office of the Inspector General, Office of Investigations are deploying targeted Health Care Fraud Strike Forces to combat health care fraud. Faculty will share recent successes and discuss areas of expansion and focus for 2013.

  • MEDIC Panel Discussion
    Thursday, 8:45 a.m. - 10:00 a.m.
    Level II

    Don DeGroff
    Pharmacist Consultant, IMS Health

    Martina Gilly
    Benefit Integrity Manager, Health Integrity, LLC

    Steven McCall, R.Ph., M.B.A.
    Director, Pharmacy Performance, CVS Caremark

    Stephen Mahmood
    Special Agent, U.S. Department of Health & Human Services, OIG-OI

    Andy Ranck, CPA
    Senior Manager, Clifton Gunderson LLP

    Melissa Rapoza
    Investigative Analyst, Health Integrity, LLC

    The Medicare Drug Integrity Contractor (MEDIC) is charged with performing Part D oversight and auditing functions, including identifying suspected fraud cases and recouping improperly paid Medicare funds. Hear ways health insurer SIUs can strengthen relations with the MEDIC, as well as recent Part D pharmaceutical fraud trends uncovered.

  • Health Insurance for the Law Enforcement Agent LEL Path
    Thursday, 10:45 a.m. - 12:00 p.m.
    Level II

    Daniel Barnett, MD, JD
    Senior Medical Director, BlueCross BlueShield of Tennessee

    Alanna M. Lavelle, AHFI, MS, CPC
    Director, Special Investigations, WellPoint, Inc.

    Jack Price, AHFI, ALHC, CFE
    Chairman, NHCAA Board of Directors

    Designed for law enforcement agents working with health insurers, this session provides a deeper understanding of health insurance operations and procedures. The first half of the program delves into the claims process, following the life cycle of a claim through auto adjudication (or paper submission), to remits, adjustment and audits. Understand how claims are paid, as well as insurer penalties for not paying a claim promptly. The second half focuses on the health insurer's relationship with the providers, examining network contracting and non-participant providers, the credentialing process, quality and medical management functions and the peer review process.

  • Jury Appeal (R) Mgmt Path
    Thursday, 10:45 a.m. - 12:00 p.m. | Friday, 9:45 a.m. - 11:00 a.m.
    Level II

    Daniel Bernstein
    Assistant U.S. Attorney, U.S. Dept. of Justice, Southern District of Florida

    Christopher J. Clark
    Assistant U.S. Attorney, U.S. Dept. of Justice, Southern District of Florida

    What makes a health care fraud case compelling to prosecutors, and appealing to juries? Two seasoned prosecutors provide tips on how agents and health insurance investigators should build cases that are both jury friendly, as well as have the greatest opportunity for a positive outcome. Subjects to be covered include assessing and demonstrating the physical and emotional harm to patients, establishing the existence of intent, the need to simplify complex health care reimbursement rules, and demonstrating the extent of the financial losses. Case examples will be discussed.

  • The Future of Enrollment Fraud under Health Care Reform Mgmt Path
    Thursday, 1:30 p.m. - 2:30 p.m.
    Level III

    Carolyn Ham, AHFI, JD
    Associate General Counsel, OptumInsight

    Assuming HCR reforms are found to be constitutional, in 2014, individuals and small groups will be able to obtain health insurance with no pre-existing conditions and very limited underwriting through state health care exchanges. This session will explore how this change will impact the motivations and actions of individuals and small group employers and outline strategies to identify and prevent fraudulent claims. Prepare to shift investigation of enrollment fraud from looking at individual misrepresentation of health condition to focus on verifying identity and residence of individuals and small groups.

Life, Disability, Long-term Care and Workers' Compensation Track
Hear case studies of fraud investigation in the life, disability, workers' compensation, and long-term care insurance arenas.
  • Complex Disability Claims: A Best Practice Approach AHFI Path
    Wednesday, 11:00 a.m. - 12:00 p.m.
    Level II

    Thomas Reeder, MD
    Senior Vice President & Medical Director, Mutual of Omaha Insurance Company

    The Mutual of Omaha Disability Claims evaluation team has adopted a multidisciplinary claim examination format that brings together a claims analyst, a medical director, a vocational rehabilitation specialist, and a special investigations representative to evaluate difficult and complex disability claims. Faculty will demonstrate the value of coordinating the appropriate disability claims resources to review the available claims information, allowing immediate input from the appropriate expert resources and resulting in the best guidance for further evaluation, investigation, and adjudication of a claim.

  • Life Insurance Fraud Red Flags
    Wednesday, 2:00 p.m. - 3:00 p.m.
    Level II

    Mik Kelly, CFE, LTCP, Registered Representative
    Lead Investigator, Investigative Services, John Hancock Financial Services

    As life insurance products increased in complexity and sophistication, so has fraud. Life insurance investigations go beyond uncovering material misrepresentations of health and faked death claims to investigating complex premium and ownership arrangements, STOLI and LILAC transactions, organized fraud and identity theft. Using case examples, this session will examine suspect indicators and the unraveling and resolution of insurance fraud cases.

  • Understanding the Nuances of Long-Term Care Insurance Fraud
    Thursday, 1:30 p.m. - 2:30 p.m.
    Level II

    Matt Aldy, PCI
    Senior Special Investigator, Mutual of Omaha

    Blake Cole, CFE
    Lead Investigator, Mutual of Omaha

    Gain a deeper understanding of the LTCI product marketplace, purchasers, and the evolving benefits. Through case examples grasp the various ways the product is defrauded, as well as effective detection and prevention strategies.

  • Investigating Workers' Compensation Fraud AHFI Path
    Thursday, 2:40 p.m. - 3:40 p.m.
    Level II

    Dominic Dugo
    Deputy District Attorney, Chief, Insurance Fraud Division, Director of Fraud Grants San Diego County District Attorney's Office

    San Diego has been on the forefront in combining successful prosecutions with high profile prevention campaigns designed to reduce workers' compensation fraud. In this session examine how to investigate both workers compensation insurer and claimant fraud, with an emphasis on public-private cooperation for more effective prosecutions.

Anti-Fraud Technology Solutions Track
Follow investigations that uncover new trends and schemes within the industry.
  • The Yin and Yang of Healthcare Fraud Detection
    Presented by Verisk Health, an NHCAA Platinum Supporting Member
    Wednesday, 9:15 a.m. - 10:30 a.m.
    Level II

    Karthik Balakrishnan, Ph.D.
    Senior Vice President, Fraud Solutions and Analytics, Verisk Health

    Jeff Young
    Vice President, Fraud Control, Verisk Health

    From group and home health to pharmacy and dental, fraud remains a cat-and-mouse game, usually leaving investigative units a step behind. Traditionally, human expertise has been the cornerstone of uncovering fraud. Recently, however, new data sources and emerging analytics have brought novel capabilities for systematic detection and discovery of complex fraud patterns. In this session we will present that neither of these two modalities is sufficient, but rather, a combination of the two - the Yin and the Yang - provides the most effective solution. And through various case studies we'll illustrate the value of this integration, and how leveraging human expertise and analytics you can more effectively fight fraud.

  • Tech Trend: Using the Latest in IT for More Efficient Case and Workload Management
    Presented by General Dynamics Information Technology, an NHCAA Platinum Supporting Member
    Wednesday, 9:15 a.m. - 10:30 a.m.
    Level II

    William Palmisano, AHFI, CFE, CSPO
    Product Manager, General Dynamics Information Technology

    Brian Zonis
    Account Manager, General Dynamics Information Technology

    Case management has always been an integral part of a Special Investigations Unit (SIU) investigator's job. Without effective - and complete - case files, a health plan's negotiating stance can be weakened or case prosecution damaged. The approach to case and workload management has taken many forms. Paper files still exist, but today's budget and resourced strapped SIUs need to leverage technology to improve their efficiency. Greater regulatory scrutiny and evolving demands for auditable information also point to a better way to optimize the case flow process. Join us for this Tech Trend session as we: discuss typical case management challenges and how new technology can help you avoid them, examine the five things every SIU case management system should include and review the three most important things your case management vendor should offer.

  • Before Claims Fraud - What about Eligibility Fraud?
    Presented by SAS, an NHCAA Platinum Supporting Member
    Wednesday, 11:00 a.m. - 12:00 p.m.
    Level II

    Jay King
    Manager, Advanced Analytics Lab, SAS

    Julie M. Malida
    Principal for Healthcare Fraud, Enterprise Financial Crimes Practice, SAS

    By 2014, as a result of the Affordable Care Act, the U.S. will experience an explosion in people eligible for Medicaid. Undoubtedly there will be confusion and expanded opportunities to intentionally misrepresent eligibility status. Medicaid agencies, Managed Care Organizations (MCOs), health plans administering Medicaid business, and state Medicaid personnel must be prepared to mitigate the impending risk. Join SAS to learn how leading state governments and private plans make the most of technology to ferret out eligibility fraud and abuse.

  • A Day in the Life of a Claim
    Presented by IBM, an NHCAA Platinum Supporting Member
    Wednesday, 2:00 p.m. - 3:00 p.m.
    Level II

    Robert McGinley
    Senior Managing Consultant, IBM

    James V. McCall, AHFI
    Solutions Consultant, IBM

    Learn about the IBM Smarter Analytics Signature Solution for Anti-Fraud, Waste and Abuse. This portfolio of outcome-based analytics solutions address the most pressing industry and functional challenges by bringing together the breadth and depth of IBM's intellectual capital, software, infrastructure, research, and consulting services to deliver break-away results.

  • Using Regulatory and Behavioral Analysis to Detect Fraud, Waste and Abuse
    Presented by HMS, an NHCAA Platinum Supporting Member
    Wednesday, 3:10 p.m. - 4:10 p.m.
    Level II

    Josh Frankel, CPC
    Senior Operations Manager, Regulatory Research/Compliance and Special Analytics, HMS

    Shawn Salkeld, BA, MBA
    Vice President of Fraud, Waste, and Abuse, HMS

    Where can the majority of fraud, waste, and abuse (FWA) cases be found and the most dollars recovered? For most SIUs, the answer will be upcoding, duplicate bills and split billing because of volume. Areas can be targeted by automatically applying Medicaid regulations to claims data and, to an extent, prevented prior to claims payment. In the fight against FWA, the most effective tool is a regulatory compliance solution that is current with regulatory changes and trends and allows SIUs to identify and prevent such behaviors. States are working within the mandates of the new NCCI requirements to adjust/develop their billing and coding requirements accordingly, and to address the upcoming ICD-10 changes. HMS' Regulatory Research and Compliance Department, which monitors Medicaid regulations for regulatory development, has noted an increase in Medicaid regulations regarding modifiers, i.e., new regulations that increase modifier submission requirements, particularly Modifier 25 and diagnosis to service code-based coding requirements. In this workshop, the presenters will discuss trends and changes that Medicaid programs and health plans have made over the past year in combating FWA through regulatory development. The presenters will also discuss how state and federal regulations are continuously adapting, and how these changes impact the practical regulatory application for MCOs.

  • Provider Morphing: Finding the Next Abusive Scheme
    Presented by Optum, an NHCAA Platinum Supporting Member
    Wednesday, 3:10 p.m. - 4:10 p.m.
    Level II

    Joseph Asta
    Vice President, Predictive Analytics, OptumInsight

    David Falk, MD
    Medical Director, Payment Integrity, OptumInsight

    SIUs spend a lot of time hunting for the next new revenue maximization scheme - combing documentation for policy and procedure changes, mining databases for outliers, etc. And yet there exists an often overlooked indication of the next new scheme: the providers we have already caught abusing the claim payment system. Health care providers intent on revenue maximization through upcoding, unbundling, modifier abuse and similar techniques aren't going to stop abusing the system because one activity has been flagged - they will likely shift their behavior to a new scheme.

  • Proven Analytics and Innovations to Fight Fraud
    Presented by Truven Health Analytics, Formerly Healthcare at Thomson Reuters
    Thursday, 8:45 a.m. - 10:00 a.m.
    Level II

    Mark Gillespie
    Senior Director, Truven Health Analytics

    Jean MacQuarrie
    Vice President, Truven Health Analytics

    David Nelson
    Senior Director, Truven Health Analytics

    What are the drivers of health care fraud? What techniques work to prevent it? This session, lead by experts at Truven Health Analytics, formerly the Healthcare Business of Thomson Reuters, will review innovative ways for debunking fraud schemes. We will discuss predictive analytics, credentialing, clinical methodologies and early stage detection and surveillance for deterring fraud, waste and abuse in the health care payer world.

  • ICD-10 Transition for the SIU - Preparation
    Presented by CGI Federal, an NHCAA Platinum Supporting Member
    Thursday, 10:45 a.m. - 12:00 p.m.
    Level II

    Robert Haskey, MD, DABS, FACS
    Executive Medical Director, CGI Federal

    From the original 179 codes developed to categorize causes of death to the introduction of ICD-9 CM in 1973, the list of diagnosis codes and procedure codes has grown substantially. Although officially delayed by one year to October 1, 2014, ICD-10 remains on the horizon and ICD-10 CM/PCS will contain over 69,000 diagnosis codes and 72,000 procedure codes respectively. This session will help the SIU investigator and manager continue the preparations initiated at our presentation at the 2011 NHCAA ATC in Atlanta, when we discussed the general issues involved. Due to the increase complexity of the ICD-10 system and a substantive interval during which the SIU will be dealing with two coding schemes that, in many cases, have only indirect cross reference, the ill-prepared SIU will be faced with a monumental task. This session will take the next steps - a discussion of preparation steps the SIU will need to initiate now to be prepared for 2014.

  • Using Smart Analytics to Eliminate False Positives and Increase the Efficiency of Your Resources
    Presented by Emdeon, an NHCAA Platinum Supporting Member
    Thursday, 10:45 a.m. - 12:00 p.m.
    Level II

    Kelli L. Garvanian, AHFI
    Payment Integrity Solutions Consultant, Emdeon

    Bart Masters
    Statistician, Emdeon

    False positives drain your resources. With advances in technology and data access, you can lessen their impact. Learn how using smarter analytics can help keep you focused on the cases that really are... well, real.

  • Fraud Waste and Abuse - The Next Generation
    Presented by Verizon, an NHCAA Platinum Supporting Member
    Thursday, 10:45 a.m. - 12:00 p.m.
    Level II

    David Botsko, Ph.D., CFE
    Managing Principal, Healthcare, Verizon

    Debra Faulkner
    Managing Principal, Healthcare, Verizon

    Connie Schweyen
    Managing Principal, Healthcare, Verizon

    Understand the patterns of fraud, where to find it, how to detect, and when to act. The old pay and chase model of fraud management is inefficient and costly. Learn how you can catch crime before it happens and how a near real time fraud management solution can ensure near time results.

  • The Case for Virtual SIU?
    Presented by EDIWatch, a LexisNexis Company, an NHCAA Platinum Supporting Member
    Thursday, 1:30 p.m. - 2:30 p.m.
    Level II

    Kate Rahimzadeh, RN, BSN
    Manager, Analytics Recovery Services Health Care, EDIWatch, a LexisNexis Company

    Tom Figurski
    Manager of Special Investigations\Internal Audit, Gateway Health Plan

    Are you looking to turn tips into recoveries? Finding lots of leads but have no resources to follow up? Are budgets holding your SIU expansion down? In this distinctive presentation, EDIWatch, Inc. will look to solve the business problem, with a new twist. Learn from a successful health plan how utilizing Virtual SIU services held down their operating costs while boosting investigation results and increasing dollar recoveries. Add muscle to your SIU without the inconvenience and expense of recruitment and training. The exploration of initial strategies and the introduction of high-level case studies will enable you to return to work with a more thorough and confident sense of what may be the answer to increasing your SIU revenues.

  • Better Investigation with Analytics: Real Life Learning Examples
    Presented by McKesson Health Solutions, an NHCAA Platinum Supporting Member
    Thursday, 1:30 p.m. - 2:30 p.m.
    Level II

    Mabel Barnes, MHA, AHFI
    FWA/SME Solutions Consultant, McKesson Health Solutions

    Bill Frank
    Director, Product Management, McKesson Health Solutions

    Coding tactics that exploit payment and medical policy holes. Circumventing of contract terms in order to maximize reimbursement in newer treatment areas. Systemic glitches that allow wasteful claims payment. The end game is to prevent as much of this waste, abuse and fraud as possible. Is it achievable? You can prevent that which you know, but how do you catch new or unknown fraud schemes or emerging abusive billing practices early? How can you stop them from happening again somewhere else once you identify them? The answer lies in a three step process: 1) optimize your claims editing system to automatically deny or pend all the wasteful or abusive billing practices common in the industry.you might be surprised at the holes you're leaving open; 2) Apply continuously learning neural analytics to detect new patterns both pre- and post-pay; 3) After acting on the analytics with fast decisions of pay/deny/route to investigation, optimize your claims editing system again, this time with the new analytic findings. Health plans have found astonishingly positive results identifying millions of dollars in annual savings opportunities by taking this approach. This session will highlight real examples to discuss each step in the process.

BREAKFAST SESSIONS | THURSDAY, NOV. 15 | 7:00 A.M. - 8:30 A.M.

  • Virtual Identity Fuels Anonymous Cyber Economy
    Presented by Booz Allen Hamilton, an NHCAA Premier Supporting Member

Scott Dueweke
Senior Associate, Booz Allen Hamilton

Bill Fox, JD, MA
Principal, Booz Allen Hamilton

Jason Hunter
Lead Associate, Booz Allen Hamilton

Benjamin S. Wright
Senior Associate, Booz Allen Hamilton

Financial fraud has evolved from its origins as a local phenomenon (i.e., individual consumer rip-off) into a formidable global challenge that involves sophisticated money-stealing schemes. The savvy and well-funded criminal enterprises that perpetrate financial cyber attacks, identity theft, "phantom provider" claim submissions, and soon perhaps individual health records, require digital money laundering tools and related techniques to fluidly, secretly and repeatedly convert substantial amounts of stolen currency into legal tender as part of a constant money-moving shell game that keeps law enforcement authorities at bay. Internet-enabled malicious activity thrives on the ability to covertly move money, and anonymous payment systems are a fundamental element of the cybercrime infrastructure.

 

  • The Payment Integrity Paradigm Shift: Ensuring Financial Health of your Organization
    Presented by Emdeon, an NHCAA Platinum Supporting Member

Jean Lyon, RN, MS
Vice President, Payment Integrity, Emdeon

How does your pre-payment versus post-payment fraud prevention program measure up? What are the benefits and risks of both methods? Explore the evolution from pay & chase to a complete pre-pay through post-pay solution. Learn the components of a successful pre-payment investigation, along with a number of case studies that will illustrate the advantages of the pre-payment approach.

 

  • Driving Down FWA with Predictive Analytics and Organizational Alignment
    Presented by FICO, an NHCAA Premier Supporting Member

Girish Pathria
Senior Director of Product Management - Insurance Fraud Solutions, FICO

Anne Donovan
Vice President, Program Integrity, AMERIGROUP Corporation

Healthcare insurance FWA continues to plague payer organizations with significant financial impact. Sophisticated predictive analytics are gaining ground in helping payers detect and prioritize FWA incidents for greatest financial advantage by uncovering previously unknown schemes. In this session, you'll hear how AMERIGROUP created a cohesive organizational approach as part of their strategy for effectively fighting FWA in healthcare insurance claims. Combined with the power of FICO's Insurance Fraud Manager's advanced predictive analytic models, they are able to more effectively detect suspicious activities at the claims and the provider levels, leading to higher rates of successful FWA abatement.

 

  • Fraud Investigations: The Human Touch vs. Technology
    Presented by Healthcare Fraud Shield, an NHCAA Premier Supporting Member

Steve Halper
Managing Member, Healthcare Fraud Shield

Mike Moseler
Chief Technology Officer, Healthcare Fraud Shield

Karen Weintraub, MA, AHFI, CPC-P, CPMA
Executive Vice President, SIU, Healthcare Fraud Shield

In this session faculty will walk through some examples of how investigators can be proactive and the tools they can utilize without sophisticated software packages. Additionally, faculty will shift gears demonstrating how unique data sources and insights into technology can complement and at times enhance those investigations.

 

  • Building a Coalition to Engage Patients in the Fight against Healthcare Fraud
    Presented by ID Experts, an NHCAA Premier Supporting Member

Bob Gregg
CEO, ID Experts

Sam Imandoust
Legal Analyst, Identity Theft Resource Center (ITRC)

Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI
Senior Investigator, Blue Shield of California

Robin Slade
Development Coordinator, Medical Identity Fraud Alliance

Healthcare fraud is a growing problem in America. The FBI estimates that between $78 billion and $234 billion of the $2.7 trillion Americans spend on healthcare will be lost to healthcare fraud in 2011. Because Explanation of Benefits (EOB's) can be complicated for patients to comprehend, the "consumer" is traditionally passive in regards to healthcare fraud, only concerned that their medical services are being paid. This growing, costly drain on the U.S. healthcare system requires a new approach centered on patient engagement. The solution: a coalition among healthcare industry anti-fraud leaders, governmental regulators, law enforcement, healthcare plans and patient advocacy organizations.

 

  • The Tip of the Iceberg - Are you missing more than you're seeing in your Fraud Recovery Program
    Presented by LexisNexis, an NHCAA Premier Supporting Member

Clint Fuhrman
National Director, Government Healthcare, LexisNexis

Open sourced big data analytics, now available in "the Cloud" can be leveraged today to unravel our greatest fraud challenge - organized fraud rings. More and more investigators are finding that virtually every case leads to a more tangled and complex picture than first imagined. We are only seeing the tip of the iceberg. "Big Data" is not some complicated theory - it's the information you're missing in your own data sets that prevent you from finding massive amounts of hidden fraud. In this session you will get a down to earth understanding of what big data is, where it is and how it can be leveraged today with advanced analytics, to improve triage, investigation and recoveries.

 

  • Fraud, Waste and Abuse in Long Term Care Services
    Presented by Xerox, an NHCAA Premier Supporting Member

Frank A. Spinelli
Vice President, Long Term Care Solutions, Government Healthcare Solutions, Xerox State Healthcare, LLC

Sara Fitzsimmons
Director, Program Management Services, Government Healthcare Solutions, Xerox State Healthcare, LLC

As the population continues to age the costs of health care services for this population is growing at an exponential rate and so is the amount of fraud, waste and abuse in the related service areas. Our presentation explores current trends in LTC and innovative solutions to identify detect and prevent fraud, waste and abuse activities. We will focus on several segments of long term care including pharmacy, home healthcare services, hospice, and long term care facilities.

Back to ATC