Program

PRECONFERENCE PROGRAMS
Make your plans to arrive early so you can to attend one of the following preconference programs.

AHFI Prep Course | 7 CPEs (8:30 am - 4:30 pm)
Prepare to sit for the Accredited Health Care Fraud Investigator (AHFI®) exam by participating in this preconference program, designed to highlight key content areas on the AHFI® examination including:

  • The Nature and Scope of The U.S. Health Care System
  • The Business and Operations of the Health Care Insurance System
  • Prevention, Identification and Detection of FWA
  • Investigative, Resolution and Reporting Process

This course should serve as a “refresher” on information that a seasoned investigator
should already know.

A paper exam is no longer available. Online testing only. You can take the prep course without applying to take the exam.

Coding: It's a Numbers' Game | 5 CPEs (9:00 am – 3:00 pm)
The annual coding pre-conference program focuses on the CPT series of codes by the numbers. This year faculty will walk through CPT codes and address current schemes. Participants will be able to ask questions and dive into case examples in this always entertaining and engaging educational program. Participants will once again walk away with information necessary to investigate providers.

Faculty

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

Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI
Director, Special Investigations Unit, Blue Shield of California

Kathleen A. Shaker, RN, BSN, CPC, CPC-H, AHFI
Investigative Consultant, Healthcare Fraud Shield

Karen Weintraub, MA, CPC-P, CPMA, AHFI
Executive Vice President, SIU, Healthcare Fraud Shield

Honing Investigator Skills and a New Twist on Managerial Oversight with Data | 4 CPEs (12:30 pm - 4:30 pm)
Four rapid fire modules focused on building and honing various investigative skills, as well as improving managerial oversight capabilities through the application of “data.”  At a micro-level topics will include skills and techniques for interviews and onsite inspections/field work; ‘how-to’ handle LARGE and complex investigations; and ‘how-to’ fuse data intelligence with SIU management.

  • Module I – Interview Skills and Techniques
  • Module II – Onsite Skills and Techniques
  • Module III – Organizing a Case  
  • Module IV –A Fusion of Data and SIU Management

SEMINARS

End your conference experience with these hands-on seminars designed to delve more deeply into topics and issues that are critical to your training needs.

Examining CDT Code Updates and Emerging Trends Dental Fraud (9:00 am - 11:00 am)
Yearly updates to the CDT Code can provide new opportunities for fraud, waste and abuse--- in addition to the emerging trends and habitually common dental fraud schemes.  To augment the investigator’s skill set, this session will provide examples of schemes related to the 2018 and 2019 CDT code updates for the reporting of teledentistry, occlusal guards and the application of an interim caries arresting medicament.  Case examples of emerging trends across a variety of clinical service areas will be presented along with examples of historically common schemes which continue to exist within both the Commercial and Public sectors. Associated Medical cross coding will be identified in the case examples presented.

Faculty

Stewart Balikov, DDS, AHFI
Director of Dental Special Investigations, Anthem

Jason Coomer
Senior SIU Dental Fraud Investigator, Humana

U.S. v Esformes: Breaking Down the Largest Medicare Fraud Scheme (9:00 am - 11:00 am)
In 2016, the DOJ charged Philip Esformes and 2 others with engaging in a complex Medicare fraud scheme that resulted in $1 billion to Medicare. Esformes ran a complex system of nursing homes, skilled nursing facilities and hospitals in South Florida. He moved patients throughout each of his facilities to maximize Medicare reimbursement and paid kickbacks and bribes to receive referrals to include patients into this cycle and get advanced notices of state inspections of his facilities. In February 2019, prosecutors took the case to trial. This two-part seminar will focus on the investigative tactics and the prosecutorial strategy of this case. In part one, the agents who worked the case will highlight the investigative techniques used to uncover the scheme and the fraudulent billing practices. The second part of the seminar will offer insights into the prosecution’s method and review the types of evidence used at trial.

Faculty

Ricardo Carcas, CFE
Special Agent, Miami Regional Office, HHS/OIG/OI

Allan Medina
Assistant Chief, Fraud Section, Criminals Division, Department of Justice

Elizabeth Young
Trial attorney, Fraud Section, Criminals Division, Department of Justice

Jim Hayes
Trial attorney, Fraud Section, Criminals Division, Department of Justice

Health Care Fraud Investigation Ethics Seminar (9:00 am - 11:00 am)
Each year, NHCAA hosts this two-hour seminar on professional and investigative ethics for the health care fraud investigator. The program will combine lecture with group discussion and will focus on practical ethical challenges faced by investigators in the areas of evidence, interviewing, professional and business activities, privacy, as well as review legal and regulatory requirements. This seminar is designed to meet the American Certified Fraud Examiner CFE ethics training requirement.

Faculty

Nicholas J. Messuri, Esq.
Vice President and Deputy General Counsel, Fraud Prevention & Recovery, DentaQuest

Ralph Carpenter
Retired  Senior Director, SIU, Aetna, Inc.

Sara A. Walker, Esq.
Vice President, Enterprise Risk Management, Blue Cross Blue Shield of Massachusetts

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