Online NETS 2013 Archive

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In-Person NETS
 

Tuition-Free registrants must use the registration form to register for Online NETS programs. Paid registrants may also register online, using the links provided below.

The programs listed below are group Internet based offerings. Reivew computer requirements on the Adobe Connect webpage.

Program Levels & Prerequisites

Level I - Little or no investigative / health care / 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 - Some investigative / health care / coding expertise is assumed, and training content is focused on the investigative process, using case examples to highlight investigative strategy and techniques.

Level III - Designed to meet the needs of 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.

PROGRAMS

"Selling" Your Case to Law Enforcement

Faculty will discuss techniques for picking and presenting cases to federal law enforcement. Examine critical early steps such as the investigative plan and analyzing the allegation, learn the most effective ways to package and present cases to law enforcement as well as ways to explain benefits of case prosecution to management and third parties.

After completing this program attendees will be able to:

  • List four items to consider before bringing your case to LE
  • Cite what should (and shouldn't) be included in your case referral synopsis
  • Identify the five ways juries think and how they affect presenting cases to LE
Available Sessions

February 6 | 2:00 pm EST

February 21 | 2:00 pm EST

Faculty

Howard Levinson, DC, AHFI, CFE, DABFP, CPC
Clinical Director
Fraud Investigations, WellPoint, Inc.

Jeffery Gunn (Invited)
Special Agent
U.S. Dept. of Justice, Federal Bureau of Investigation

Program Credits & Prerequisites

Credits: 2 CPEs

Level: Intermediate (II)

Prerequisites: See Level II description for content mastery recommended, no other advance preparation required.

Field of Study: Specialized Knowledge & Applications


Coding Clinic: Modifiers*

Participants will be guided through modifiers commonly abused or misused. Review a broad range of schemes across several specialty areas including: E&M, surgery, laboratory services, preventive services, and others. Modifiers discussed will include: 21, 24, 25, 51, 59 and 78.

After completing this program attendees will be able to:

  • List modifiers that are frequently misunderstood or misused
  • Recognize red flags of modifier abuse in a medical record
  • State 2013 modifier changes/updates
Available Sessions

March 21 | 2:00 pm EDT

April 23 | 2:00 pm EDT

Faculty

Brian Koch, CPC
Medicare Fraud Investigator
Regence BlueCross BlueShield of Oregon

Barbara Scott, RN, AHFI, CPC, CFE
Investigative Consultant
Blue Cross Blue Shield Association

Program Credits & Prerequisites

Credits: 2 CPEs

Level: Intermediate (II)

Prerequisites: See Level II description for content mastery recommended, no other advance preparation required.

Field of Study: Specialized Knowledge & Applications

*This program has the prior approval of AAPC for 2 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.


Understanding Pharmacy Claims

Examine pharmacy fraud through each step in the life cycle of a claim. Scrutinize areas susceptible to fraud, and review common and emerging schemes, red flags and investigative strategies. Understand the critical role of Pharmacy Benefit Managers and learn ways to create a partnership against pharmacy fraud.

After completing this program attendees will be able to:

  • Define the steps of the life cycle of a pharmacy claim
  • List three pharmacy schemes
  • Explain the role of a Pharmacy Benefit Manager
Available Sessions

May 22 | 1:00 pm EDT

June 18 | 1:00 pm EDT

Faculty

Anne Sayther, CCSA
Director, Pharmacy Audit
Prime Therapeutics, LLC

Hannah Kokesh
Senior Lead Pharmacy Auditor
Prime Therapeutics, LLC

Program Credits & Prerequisites

Credits: 2 CPEs

Level: Intermediate (II)

Prerequisites: See Level II description for content mastery recommended, no other advance preparation required.

Field of Study: Specialized Knowledge & Applications


Investigating Mobile Services

Understand schemes, learn investigative techniques, and discuss coding and medical record review for a variety of mobile services such as diagnostics, general wellness, behavioral health, cardiology, and vision.

In addition, hear a case study 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.

Available Sessions

July 9 | 1:00 pm EDT

August 15 | 1:00 pm EDT

Faculty

William (Robert) Banter, AHFI, CFE
Auditor, Indiana Medicaid Fraud Control Unit

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

Janette Taylor, RN, CPC
Manager Fraud Control, Group Health, Verisk, Inc.

Jeff Young
Vice President, Fraud Control, Verisk Health - Payment Accuracy