Call for Presentations

NHCAA is seeking health care anti-fraud professionals to share best practices, case studies, emerging schemes, investigative or clinical skills, proven data mining techniques, and investigative solutions in 2018.

Review the scheduled 2018 National Education & Training Series (NETS) programs and submission guidelines below prior to completing a call for presentations survey.

Who Should Submit
Planning Your Submission
Submission Review Process
Speaker Expectations

Use the tabs below to view details on the topics selected by the Education & Training Committee and submit your presentation ideas. 

Types of Sessions Being Considered

The 2018 NETS programs will contain four types of sessions. During your submission, you will be asked to select the session type that best matches your presentation. 

Data Analysis - hands-on sessions limited to 30 participants with laptops, exclusive to the Skills & Schemes program. Facilitator will use deidentified data to demonstrate, and walk participants through, numerous ways to manipulate data in excel to analyze for red flags. Session should include ways to present the data to investigators, management, or law enforcement for maximum impact and accessibility. We anticipate participants will have a working knowledge of excel, but will not be experts in data manipulation.

Case Study – showcase a specific case (or group of cases) through a detailed walk-through. Presentation should explore all phases of the investigation: how the case was found, including pertinent analytics, how the scheme worked, investigative strategies used, resolution of the case, lessons learned, and at least three takeaways for attendees.

Scheme Development – this broad category includes a variety of topics including those that:

  • focus on the intricacies of how a scheme operates,
  • explain the clinical and billing / coding aspects of an investigation, or
  • foster an understanding of fraud schemes and challenges unique to government programs.
Case examples may be used to provide context to presentation material, but the focus should be on the scheme or clinical details.

Skill Building – examine components of skills necessary to successful investigations. Sessions should emphasize ways to enhance and refine skills, ideally with examples of improved investigative outcomes, lessons learned, and habits investigators can adopt immediately. Unless the skill is unique, no foundation building sessions (i.e., Level I) will be accepted for presentation in this category.

Webinars
Deadline: December 22

Held the 3rd Thursday of most months, webinars are 90 minutes in length and focus on building foundations and explaining methodologies for the topic at hand. Ideal sessions are educational in nature and are not in a case study format. Multiple co-presenters are encouraged. Other topic ideas are welcome.

Submit
Webinar Presentation
  • Behavioral health
  • Coding issues
  • Data analytics (example of analytics)
  • Data strategy (how to use data in broader investigation strategy)
  • Dental / medical fraud crossover
  • Disability
  • Facilities
  • Genetic testing
  • Handling electronic evidence
  • Internet search strategies
  • Labs
  • Medical identity theft
  • Medical record review
  • Pharmacy
  • Social media strategies
  • Supplemental insurance fraud
  • Vision

Rising Trends
Deadline: January 5

Rising Trends is comprised of three one-day, focused programs. The training will be held in Baltimore, Maryland from June 19 - 21. Each program builds upon a trending theme in the health care anti-fraud industry. The three topics selected for presentation in 2018 are below.

Submit
Rising Trends Presentation


Facility Fraud

Outpatient services are being considered. Educational sessions are highly desired for this program.

  • Audits
  • Ambulatory surgical centers
  • Hospital fraud (outpatient)
    • Diagnostic testing
    • Emergency department
    • Labs
    • Partial hospitalizations
  • Imaging services
  • Long term care
  • Skilled nursing facilities
  • Substance abuse centers
  • Urgent care

Examining Emerging Trends
We are seeking new schemes, investigative and prosecutorial strategies, or emerging variations on existing schemes that may not be well known in the industry. Sessions may be in scheme development or case study format.

  • Exchange / marketplace
    • Medical tourism
  • Functional medicine
  • Lab issues (genetic, rural hospital, etc.)
  • Pharmacy
  • Preventative services
  • Prosecution strategies
  • Telemedicine & telemarketing
  • Unlisted concerns & trends 

Abusive Pharmaceutical Practices
This program will focus on trending issues in pharmacy, particularly those that impact patient safety. Presentations that show how plans can address fraud and increase member safety, will be given preference. We are seeking a blend of scheme development, skill building, and case study sessions.

  • Audits
  • Analytics
  • Billing
  • Collaborating with your PBM
  • Drug diversion
  • Drug recycling
  • Identity theft
  • Illegally imported drugs
  • Intra-department collaboration to assist members suspected of being addicted to pharmaceuticals
  • Lifecycle of a prescription drug
  • Lock-ins and prior authorization
  • Manufacturing & warehouse concerns
  • Part D program concerns
  • Pharmacy shoppers

Skills & Schemes for the Health Care Fraud Investigator
Deadline: January 19

This three-day program will be held in Denver, Colorado from August 7 - 9 and will consist of four session types: scheme development, skill building, case study, and data analytics. Presentations falling under the scheme development, skill building, or case study categories may also be considered for a data analysis session.

Specific topics of interest are listed below; however, submissions on any topic are welcome.

Submit
Skills & Schemes Presentation


Data

Topics listed below are specific to the Data Analysis session type. Presentations should demonstration how to analyze data for red flags related to the following schemes:

  • Behavioral health
  • Cardiology
  • Dental
  • Durable Medical Equipment
  • Facility
  • Identity theft
  • Laboratory
  • Pharmacy

Investigative Skills

  • Data communication & visualization
  • Interviewing:
    • Interviewing witnesses
    • Interviewing unique populations
    • Telephone interviewing techniques
  • Internet and social media tools
  • Managing cases to avoid pitfalls
  • Medical record requests & review (any specialty):
    • Anatomy of a record - what is required to be legitimate
    • Electronic health records
  • Negotiating techniques

Clinical & Coding

  • Autism/Applied Behavior Analysis
  • Anatomy & physiology review of systems with coding and medical record implications
  • Cardiology
  • Coding challenges (any specialty)
  • Non-physician billers
  • Pain management

Schemes

  • Air ambulance
  • Allergy / immunology
  • Alternative medicine
  • Ancillary services
  • Behavioral health
  • Dental, beyond the basics
  • End stage renal disease
  • Home health
  • Lab issues
    • Allergy testing
    • Drug testing
    • Genetic testing
    • Rural labs
  • Orthopedics
  • Out of network providers
  • Plastic surgery
  • Pulmonology
  • Urology
  • Vision

Government Programs
Focus on Medicare and Medicaid / Medicaid Managed Care issues, though sessions concerning other government programs are welcome:

  • Dual eligible populations
  • Exchanges / marketplace (special enrollment, ID theft, broker, kickbacks, etc.)
  • Home health
  • Hospice
  • Inter-program collaborations
  • Long term care
  • Managed care
  • Patient recruiting
  • Pharmacy / drug diversion
  • Quality of care
  • Technology and data