Call for Presentations

The NHCAA Institute for Health Care Fraud Prevention is now accepting abstracts for the 2019 Annual Training Conference, October 15-18, 2019 in Nashville, Tennessee.  

The ATC Committee has developed a comprehensive list of tracks and topics for this year. Please review the information carefully as some new tracks were established this year.

The Call for Presentations for the Annual Training Conference (ATC) will close on Wednesday, March 20.  Presentation submissions will be reviewed and evaluated by the ATC Committee for inclusion in the program.  Accepted submissions will be announced in May.

New This Year:

  • Session levels: Our goal is to provide additional clarification to the attendees and faculty on the session levels. Please select the session/ presentation level carefully when completing the submission form.
    • Entry - designed for individuals between 1-5 years
    • Intermediate - designed for individuals between 6-10 years 
    • Experienced - designed for individuals with over 10 years’ experience  
  • Session Outline: Upon acceptance, faculty will be asked to submit an outline of the educational session. This outline can help you to build your presentation.
  • Data Analytics: The ATC Committee is once again 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.  When submitting the abstract, provide the following information:
    • What data techniques were used to find the scheme? (if applicable)
    • How do you use analytics to drive an investigation?
    • Who is the audience for the session - the investigator vs. data analyst?
    • What are the codes identified in this scheme (CPT, ICD-10, HCPCS, REV codes)?

Once Again:

  • New presentations, experienced presenters - Presenters from the past are always welcome, but we request that you DO NOT submit a presentation that was already presented at a previous ATC.
  • Session take-aways - There continues to be an emphasis on ensuring 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. However, please know that abstracts that address a new fraud scheme or vulnerability that has not be previously presented will be considered as well.

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 and include a statement explaining why the topic is relevant and should be shared with others.

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.

  • Investigation life cycle
    • Walk through the steps of an investigation from receipt of an allegation to interviewing, report writing, and making a recommendation on the investigative outcome and referrals. (E.g., How did you find the scheme? How did you run the data to determine if it validates or contradicts the current theory? Who did you interview and who were your partners?)
  • 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?
    • How are you leveraging AI and machine learning?
  • Referral development to law enforcement
    • How to prepare an actionable referral with a seamless hand off?
  • Medical record review/ coding
    • How do you review 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? In person vs telephone?
  • When conducting an investigation, what should you look for when investigating any of the following schemes?
    • DME
    • Sober homes/ behavioral
    • ABA
    • Home health
    • Telemedicine

Legal and Compliance 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. 

  • 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?  What should be expected with the new audit protocols?
  • Sampling and Extrapolation, know the rules.

Leadership and Management Issues
Leadership 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).

  • Insights on building your SIU and the evolution of your team for the SIU of the future.
  • How do you present data and speak about data in a meaningful way?
  • How are you partnering in innovative ways to help prevent fraud (e.g., medical directors, PBM, credentialing)?
  • How are you applying AI and machine learning to your team’s work?
  • ‘Selling your services’ – best practices when discussing your company’s anti-fraud program with new clients.

Clinical Issues for the Healthcare Fraud Investigator
Submissions in this category should advance an investigator’s clinical understanding of health care fraud. The ATC Committee is interested in expanding the understanding of par and non-par providers, and credentialing.

  • Understanding the types of provider credentialing
  • Par and non-par provider schemes
  • Behavioral health schemes
  • Physical therapy, occupational therapy, speech therapy
  • Medical necessity determinations & fraud
  • Prior authorization – impacts on fraud case
  • Using claims history to validate services
  • ID of high member utilization
  • ID of medical waste – provider driven vs member driven
  • Patient harm
  • Provider/ employer group fraud
  • Genetic testing

Fraud in the Government 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 
    • Non-credentialed providers
    • Ineligible members
  • Long term care issues
    • Hospice
    • Skilled nursing facilities
    • Behavioral health (mental health)
  • Facility fraud – readmission billed as observation to avoid bridging/ denial

Pharmacy 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). 

Special Note: For any submissions focusing on opioids, we are looking for submissions that address the evolution of opioids and other controlled substances. What are the by-products of opioids? Where is the fraud moving? Who can provide a clinical analysis of opioids and other controlled substances? What are the new delivery methods? Where is fraud in the ancillary services for addicts?

  • Pharmacy collusion
  • Compounding
  • Pharmacy management programs
  • Effective prior authorization programs
  • Working with your PBM – investigating/ reporting
  • Diversion paired with services not rendered, etc
  • Topical/ non-compounding

Fraud in Specialty Products from Worker’s Compensation and Disability Insurance
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.

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

Detecting and Investigating Dental Fraud
Examine investigative skills and schemes specific to dental insurance. Case studies that partner with law enforcement are encouraged in this track of content.  Sessions that repeat from previous years should not be submitted.

  • Dental/ medical cross over
  • Medicaid dental fraud
  • Orthodontic schemes

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.

  • Telehealth
  • Telemedicine (dental/ medical)
  • DME- Orthodontics, Supplies – breast pumps, Wheelchairs (theft)
  • Facilities fraud – Rural
  • Transportation – Ambulance
  • Kickbacks
  • 3rd party premium payments
  • Group eligibility
  • Experimental billing ‘covered’
  • Sober homes/ residential
  • Medical ID theft
  • Lab Testing - Genetic testing, UDT, Allergy testing, Cardiac testing

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 20, 2019):

In order for your presentation to be considered by the ATC Planning Committee, abstracts must be submitted by March 20, 2019.

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.

Please share your knowledge, insights 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.

For more information and to be added to the Call for Presentations email announcements, email training@nhcaa.org.

Deadline to submit is Wednesday, March 20