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 at some of our 2019 National Education & Training Series (NETS) programs.  Note, the Annual Training Conference Call for Presentations will open in early 2019.

Please consider sharing your knowledge or expertise; working collectively and discussing your experiences is the key to winning the fight against health care fraud. Use the tabs below to submit your presentation idea(s).

Who Should Submit

  • Professionals in health care anti-fraud detection, investigation, prosecution, and prevention activities.
  • If you are a consultant or vendor to the industry, we encourage you to use this opportunity to highlight your internal subject matter experts, anti-fraud initiatives, and solutions by including an NHCAA Member Organization presenter in your submission.

Planning Your Submission

1. All submissions should include “how-to” content, best practices, and/or a diversity of perspectives. Product/company specific sales pitches will not be accepted by the review committee. Consider:

Levels
Programs considered a level II or III should not include introductory or generic information, and delve immediately into the topic.

Time
60, 75, or 90 minutes presentations. Consider number of speakers, how quickly each one presents, their prior speaking experience, the breadth and depth of material, and potential for questions, typically around five minutes.

Learning Objectives
Please provide three learning objectives. These statements specify what participants will learn during your session. Read more about how to create a learning objective.

Abstract
In 500 words or less, clearly describe what materials the session will cover, explain any emerging facets or, if a common topic, why it should be revisited, any interactive or unusual aspects of the presentation, why participants will care about this topic, and, if necessary, expand on participant takeaways.

If submitting a case study, please explain why the case is significant. Key discussion points should be: how the case started, if multiple agencies or carriers who worked the case, the scheme being perpetrated, any unique attributes, lessons learned, and the status of the case. All case study presentations will need to include at least three takeaways for the audience. 

Bio
Each presenter should submit a brief bio that includes speaking experience. In no more than 250 words please explain why you are qualified to speak and relevant industry experience. View sample bios.

2. Decide the best program fit for your session idea(s). Submissions on all topics are welcome. To see details on a training program, please review our 2019 programming schedule.

3. Submit your presentation idea(s) by the stated deadlines. If you have all the above information gathered you can anticipate the submission process to take 10 -15 minutes. You can save your progress and finish the submission later.

Once you press the “submit” button your submission has been recorded. You will receive an email with your responses from noreply@surveygizmo.com, check your spam / junk mail if it doesn't come to your inbox. Contact training@nhcaa.org with any questions.

Submission Review Process

  • The Education & Training Committee, comprised of approximately twenty representatives from health plans and federal government agencies, will review each submission and determine if it is appropriate for presentation at one of the NETS programs.
  • The committee looks at the following criteria: overall quality, relevance to the industry, well-defined focus and learning objectives, practical application of material, timeliness of the topic, and speaker qualifications.
  • Sales presentations and incomplete submissions will not be considered.
  • Selections will be made at least three months in advance of the program. All submitters will be notified of the committee’s decision on their submission(s).

Speaker Expectations

Below is what NHCAA expects from speakers at our programs and what speakers can expect from the Association.

Speakers will:

    • Participate in conference calls with NHCAA staff to develop presentation content and discuss program logistics.
    • Provide a PowerPoint presentation for the participant materials portal at least two weeks in advance of the program. All speakers, including those from law enforcement agencies, must provide at least a title slide and a slide with the takeaways for the portal. 
    • Rehearse presentation to ensure it fits within allotted time frame.
    • Arrive onsite at least one hour prior to presentation start time.
    • Deliver a quality presentation that aligns with the final advertised description and learning objectives. If presentation fails to meet this expectation, future invitations to speak will be jeopardized.
    • Set aside a few minutes after the presentation to answer participant questions.
    • Submit any reimbursement requests within 30 days of the program.

NHCAA will:

    • Notify all individuals who submitted approximately three months in advance of an in-person program.
    • Coordinate conference calls and deliver timely guidance and feedback to ensure a successful presentation.
    • Listen to speaker needs and provide appropriate audio/visual equipment and other necessary materials.
    • Provide a complimentary, non-transferable program registration and access to program materials.
    • Facilitate presentations onsite and assist with any onsite speaking or logistics needs.
    • Reimburse, if needed, speaker travel and hotel costs per our travel policy. Here's our 2018 travel policy for an idea of what NHCAA covers.

Enhancing Skills & Maximizing Investigative Strategies
Deadline: December 21

This event, comprised of three one-day, focused programs will be held June 11 – 13 in Indianapolis, Indiana. Each program builds upon a trending theme in the health care anti-fraud industry. Presentations should be designed for mid-level analysts and investigators who want to enhance their investigative techniques, build their toolbox, and expand their management skills. These separate but complementary programs, will each dive into high-level investigative skills and strategies.

Submit
Enhancing Skills Presentation


Managing Complex Investigations

Today’s fraud schemes are growing increasingly complex and investigators need to understand strategies and resources beyond the claims payment processes and analytics tools to investigate appropriately. This program will delve into the skills needed to investigate complex cases like telemarketing and enrollment schemes. More specifically, the training will focus on case management skills, internal collaboration, external collaboration with law enforcement, and team development.

Ideal presentations will focus on case studies, skill explanations, and scenario-based discussions that examine the complexity of schemes including ownership issues, contracting issues, member benefits, working within state regulations, and coding rules. 

Examining Emerging Schemes in Health Care Fraud

This program will address schemes coming down the pike. We are seeking new schemes, investigative and prosecutorial strategies, or an evoluation of an old scheme. Presentations should focus on critical data for risk assessment, scheme details, red flags, investigative strategies, and prevention. These issues may be more theoretically in nature and show investigative complexity.

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


Advancing Your Investigative Skills

This program will be driven by case study examples to help investigators/analysts take leading roles in complex investigations. Case  study or discussion based sessions should help investigators/analysts take leading roles withing investigations including leveraging dashboards, demonstrating ROI, advanced interviewing and negotiation, collaborating with law enforcement and other organizational departments, and advancing conflict resolution and negotiation skills. 

Schemes for Health Care Fraud Investigators & Analysts
Deadline: December 21

This year our annual Schemes program will be held August 20 – 22 in Orlando, Florida. Faculty should share their expertise on the evolution of health care fraud schemes and offer insights to their peers on what to investigate in their own claims systems. Utilize case studies to demonstrate what investigative strategies and analytical approaches were used to uncover and investigate common and uncommon schemes. 

Faculty may also focus on providing a detailed explination of how a particular sheme or data analytics strategy operates. A special focus in this program will be providing information on data analytics and strategies for clinical investigators.

Submissions should provide best practices, investigative insights, and approaches to fraud. Specific topics of interest are listed below; however, submissions on any topic are welcome.

Submit
Skills & Schemes Presentation


Data

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

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