Program Agenda

TUESDAY, JULY 18

  • 7:30 am Registration Open
  • 7:45 am - 8:30 am Continental Breakfast
  • 8:30 am - 9:00 am Welcome and Opening RemarksDetails Lou Saccoccio, Chief Executive Officer, NHCAA
    Stephanie Dougherty, Senior Director, Education and Training, NHCAA
  • 9:00 am - 10:15 am Session I - Leadership versus Management Details (1) Examine the difference in roles of manager and leader, and gain insights on how to move from counting value to creating value
    (2) Recognize the responsibility and expectations of leadership, and identify common management mistakes to avoid
    (3) Recognize the challenges of transitioning from peer to boss
    (4) Gain a basic understanding of systems thinking and as applied to leadership and management.

    Faculty:
    Sherry Goetze
    Human Capital Partner, UnitedHealth Group
  • 10:15 am - 10:30 am Break
  • 10:30 am - 12:00 pm  Session II - Unique Leadership Challenges in an SIUDetails (1) Discuss the organizational structure of SIU departments within a variety of organizations including the various roles and responsibilities for an SIU.
    (2) Asses the impact of the organizational structure has on decision making and strategic planning and how to get organizational buy in.
    (3) Examine the top challenges for SIU leaders that might be unrecognized by the team.
    (4) Discuss strategies for developing partnerships within your organization and recognizing the culture of your organization.

    Facilitated by: Sherry Goetze
    Human Capital Partner, UnitedHealth Group 

    Faculty:
    Richard Munson, AHFI
    VP, Investigations, UnitedHealthcare Investigations

    Tom Hixson, MS
    Audit Director, CIGNA

    Christa Jewsbury, JD, CFE, AHFI
    Director, Special Investigations Unit, Humana
  • 12:00 pm - 1:30 pm  Networking Lunch
  • 1:30 pm - 3:00 pm  Session III - Building Teams and Managing StaffDetails (1) Examine best high-performing practices for hiring, recruiting and retaining the right employees to create a balanced team.
    (2) Discuss how to set clear expectations for staff and outline the roles and responsibilities for each team member.
    (3) Examine how to set goals for investigators in your unit (case load, recoveries, referrals).
    (4) Determine methods for implementing performance metrics that help investigators embrace change.
    (5) Analyze best practices and strategies for building and managing an SIU team for the future to include remote workers and rewards.

    Facilitated by: Jackie Smith, M.ODL
    Vice President, CareSource University  

    Faculty:
    Richard Munson, AHFI, Unitedhealthcare Investigations

    Marita Janiga
    Executive Director, Investigations, Kaiser Permanente
  • 3:00 pm - 3:15 pm  Break
  • 3:15 pm - 4:30 pm  Session IV - Examining the Legal and Regulatory Challenges of the SIUDetails (1) Understand the program integrity/ compliance requirements for an SIU, and how to incorporate into your team goals.
    (2) Review legal issues for the SIU including anti-trust issues, ERISA litigation, risk communications.
    (3) Recognize the leadership challenges and pressures associated with meeting recover targets.
    (4) Discuss ways to forecast performance for the unit.

    Faculty:
    Nick Messuri, Esq.
    VP, Fraud Prevention & Recovery, DentaQuest

    Christa Jewsbury, JD, CFE, AHFI
    Director, Special Investigations Unit, Humana
  • 4:30 pm - 4:45 pm  End of Day/Wrap Up
  • 5:00 pm - 6:00 pm  Networking Reception*
    Sponsored by General Dynamic Health Solutions

    *Dinner on your own

 

WEDNESDAY, JULY 19

  • 7:30 am Registration Open
  • 7:45 am - 8:30 am Continental Breakfast
  • 8:30 am - 8:45 am Welcome Remarks Details Jala Attia, AHFI, CFE, Senior Program Director, Program Integrity Solutions, General Dynamic Health Solutions
  • 8:45 am - 9:45 am Session V - Leadership Communication Strategies Details (1) Determine ways for communicating about challenging issues and situtations, and the value of crisis communication skills.
    (2) Explore new ways to provide information to internal and external partners about investigations.
    (3) Discover proven ways of adjusting your messaging and communication style based on your audience and their needs.
    (4) Learn how to present your case without overstating the facts.
    (5) Discuss the important shift from doing an investigation to reporting to law enforcement, higher management, etc.

    Faculty:
    Daniel Kreitman, CFE, AHFI
    Director, SIU, Centene Corporation

    Marita Janiga
    Executive Director, Investigations, Kaiser Permanente

    Victoria Peters
    Senior Manager, Special Investigations Unit, Blue Cross Blue Shield of Illinois
  • 9:45 am - 10:00 am Break
  • 10:00 am - 11:00 am  Session VI - Interpreting Data and Strategic Planning Details (1) Understand the important data elements from fraud detection and recovery metrics to statistically value random sampling.
    (2) Recognize ways to leveraging metrics, utilizing data, and manage data.
    (3) Examine strategies for measuring data and translating the meaning for larger department or organizational policy changes (e.g., contracts).
    (4) Understand the data sources throughout the organization and how to collaborate with other departments to create a continuous flow of information.

    Faculty:
    Aneta Andros, AHFI
    Informatics Manager - SIU Analytics Team, CIGNA
  • 11:00 am - 11:15 am Break
  • 11:15 am - 12:00 pm  Working Lunch - Developing New Business and Managing External Vendors Details (1) Discuss best practices to prepare for a readiness review and implement the RFP process to acquire new business.
    (2) Examine ways to develop protocols for evaluating and managing detection and recovery vendors.
    (3) Identify ways to measure ROI of a vendor.

    Faculty:
    Daniel Kreitman, CFE, AHFI
    Director, SIU, Centene Corporation
  • 12:00 pm Adjourn/Wrap Up

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