Call for Presentations

NHCAA is seeking submissions for the Annual Training Conference (ATC) being held October 29-November 1, 2018 at the Anaheim Marriott in Anaheim, CA.  

The Call for Presentations for NHCAA’s Annual Training Conference (ATC) launches on February 14, 2018 and closes on March 16, 2018.  Presentation submissions will be reviewed and evaluated by the ATC Committee for inclusion in the program.  Accepted submissions will be announced in May.

The Call for Presentations includes scheme and fraud topics to help you better understand what the Annual Training Conference committee would like to see in this year’s program.

New This Year:

  • A focus on data and coding - The ATC Committee is putting a special emphasis on data and coding this year. In response to the 2017 conference evaluations, the ATC Committee is requesting that all submissions include a description of how data is used in the investigation, what codes were identified, and what can be replicated in other investigations. There will be new sections in the submission form for this information.
  • Session levels - There will a greater emphasis on the level of content presented in the session. Please select the session/presentation level carefully when completing the submission form (e.g., beginner-101, intermediate-201, experienced-301).

Once Again:

  • New topics, experienced presenters - Presenters from the past are always welcome, but we request that you submit on topics not previously presented at ATC.
  • Session take-aways - There continues to be an emphasis on making sure that attendees take away information, skills, and tools. Presenters will be required to include a closing slide that identifies three (3) things that the audience can use back in the office on their own investigations.
  • Content categories – The ATC Committee has identified schemes and fraud topics that we would like to see included in this year’s program. We encourage you to submit presentations that address one of these areas. Review the content categories tab for more information. 

The ATC Committee is seeking presentation abstracts in categories. Each category includes a list of topics identified as key issues for this year’s ATC program. This list is not comprehensive and other topics will be accepted. If you don’t see your topic, submit in our ‘Other’ category.

Pharmacy and Opioid Fraud Schemes
Submissions should include information, such as: how did the investigation begin, what were the red flags, how did you work the case, and how did you partner with other stakeholders in the anti-fraud community (e.g., local and state law enforcement, health insurer).

  • Opioids and lab schemes
  • Opioid kickback schemes
  • Compounding
  • Effective prior authorization programs
  • Working with your PBM – investigating/ reporting
  • Diversion paired with services not rendered, etc

Behavioral Health and Substance Abuse Fraud Issues
With an increased interest in behavioral health cases and mental health parity, the ATC Committee is requesting that submissions in this area include information on how to examine medical records and supporting documentation for red flags and identify specific codes that may be misused. The goal is for attendees to walk away knowing how to investigate these issues in their own organization.

  • Behavioral health - Intensity of treatment, Substance abuse, Autism
  • How do you analyze and mine behavioral health data to locate red flags?
  • What are appropriate treatment protocols, how can you identify red flags and fraud?  
  • How do you audit behavioral health treatment programs to identify fraud schemes?

Expanding Your Investigative Skills 
Submissions should focus on how to build the investigative skills of the staff in the SIU units within the insurer community as well as law enforcement. The proposals should include detail on how to build skill sets for staff and teams such as: data analytics, interviewing, preparing and presenting a case, and assessing referrals.

  • Technology 
    • How do you use social media and IP addresses in an investigation?
    • How do you find evidence in the cloud?
    • How do you collaborate with other departments in your organization to work data in an investigation?
    • What is the future of technology in investigations?
  • Data analytics
    • Data analytics for the non-analyst
    • What is the logic/ approach to analyzing data in an investigation?
  • Referral development to law enforcement
    • How to do it appropriately so it’s a seamless hand off?
  • SIU communication between organizations, plans
    • What is allowed per confidentiality requirements?
  • Medical record review/ coding
    • How do you read records?
    • What do you request when conducting an investigation?
    • What documentation support is needed?
    • How do you interpret?
  • Interviewing skills
    • What are best practices in interviewing?
  • When conducting an investigation, what should you look for when investigating any of the following schemes?
    • DME
    • Sober homes/ behavioral
    • Home health

Fraud in the Federal and State Programs
Submissions should discuss the schemes and challenges unique to the Medicaid and Medicare programs. Case studies and presentations in this category should examine fraud issues such as MCO Medicaid fraud, home health fraud, and hospice fraud. 

  • Medicare/ Medicaid
  • Special issues in dual eligible populations
  • Cooperating with Medicaid Fraud Control Units
  • Medicare Part D
  • Audits and audit prep
  • Qui tams – what’s in it for private insurers 
  • Long term care issues
    • Hospice
    • SNF (RUG manipulation)
    • Behavioral health (mental health)
  • Facility fraud – readmission billed as observation to avoid bridging/ denial

Legal, Compliance, and Management Issues
Session proposals within this category can be both higher level legal issues for experienced attorneys, but also the application of complicated concepts and what investigators need to understand to effectively work a case.  Compliance and management submissions should be designed to improve the skills set of mid and higher-level staff (e.g., managing reporting requirements, management skill building, interpreting analytics, audit preparation, and structuring recoveries).

  • ERISA and Qui Tam issues
  • What is considered discoverable in an investigation?
  • What should investigators know about the legal issues in an investigation? The do’s and don’ts of an investigation.
  • What are important health care statutes that investigators need to understand and how do they apply to an investigation?
  • What are the essential elements of a compliance program?
  • How do you manage reporting requirements? What are lessons learned that can be shared with other organizations? 
  • What are best practices in audit preparation?

Fraud in Specialty Products from Worker’s Compensation and Disability Insurance to Dental Fraud
These submissions should highlight strategies and surveillance activities for uncovering common schemes in supplemental products including disability insurance, long term care insurance, and workers’ compensation. Other submissions for this category should include current common dental fraud schemes and sleep apnea.

  • Home health, LTC, Hospice, Skilled Nursing Facilities (post-acute)
  • Workers’ comp
  • Disability
  • Dental fraud schemes
  • Vision schemes
  • Accident
  • Specified Disease
  • Indemnity Plans

Detecting and Investigating Dental Fraud
Examine investigative skills and schemes specific to dental insurance. Dental fraud schemes including dental/ clinical cross over, sleep apnea, Medicaid dental fraud, and orthodontic schemes should be included in this category.

Case Studies to Address Trending Schemes in Health Care Fraud
Our law enforcement agent and investigator audience will be interested in hearing case studies from their federal and state colleagues, along with health insurers. Case study submissions should clearly outline the role of data in the case, identify the steps in the investigation from beginning to end, outline how data was used to make the case, and explain how you worked with and communicated with the private/ public partners.

  • Lab Testing – genetics, methodology codes
  • Telemedicine 
  • DME- Orthodontics, Supplies – breast pumps, Wheelchairs (theft)
  • Foreign claims
  • Podiatry
  • Vision
  • Transportation – Ambulance
  • DME
  • Lab Testing - Genetic testing, UDT, Allergy testing, Cardiac testing
  • Kickbacks
  • 3rd party premium payments
  • Telemedicine (dental/ medical)
  • Sleep studies
  • Group eligibility
  • Experimental billing ‘covered’
  • Hospital fraud
  • Accident, hospital confinement plans
  • Chiropractor
  • Sober homes/ residential
  • Medical ID theft
  • Facilities fraud – Rural

Other
If you didn’t see the topics you are interested in submitting represented in the list, please submit your proposal in the ‘Other’ category. 

Deadline (March 16, 2018):

In order for your presentation to be considered by the ATC Planning Committee, abstracts must be submitted by March 16, 2018.

Who Should Submit:

We are interested in hearing from professionals in health care fraud detection, investigation, prosecution and prevention activities. The NHCAA Institute is proud of its tradition of offering the very best in health care anti-fraud education and training and welcomes your proposal.

If you are a consultant or solutions provider in the industry, we encourage you to use this opportunity to highlight your solutions, case studies, and initiatives by including an NHCAA member organization presenter in your submission.

Please consider sharing your knowledge and expertise with the health care fraud investigative field. Working collectively to share and learn is the key to winning the fight against health care fraud.

Sponsorship and Exhibiting Opportunities:

If you are interested in sponsorship or exhibit opportunities at our Annual Training Conference or a National Education and Training Series (NETS) program, please contact Michael Williams at mwilliams@nhcaa.org or 202.349.7985.

Please click here to submit a presentation for the 2018 Annual Training Conference.