Call for Presentations
NHCAA is seeking health care anti-fraud professionals to share best practices, case studies, emerging schemes, investigative skills, clinical knowledge, proven data mining techniques, and investigative solutions at the 2021 programs listed below.
Each of these programs will be held virtually:
- Strengthening Your Data Analytics Strategies & Techniques – Submissions Due by Thursday, January 18
- Schemes for the Health Care Fraud Investigators & Analysts – Submissions Due by Friday, February 11
- Enhancing Your Skills: Managing & Navigating complex Investigations – Submissions Due by Friday, February 25
The Annual Training Conference Call for Presentations will open in 2021.
Strengthening Your Data Analytics Strategies & Techniques
Submission Deadline: January 18
Dates: April 13 – 15
This new three-day program, geared toward experienced analysts, combines lecture, facilitated group discussion, and tutorials. Speakers will explore the skills necessary to identify systemic issues and effectively communicate findings to internal and external stakeholders. The goals of this program are to provide participants the opportunity to:
- Learn new analytics strategies and techniques.
- Examine coordination and communication with internal and external stakeholders.
- Review software, like SAS, Access, Excel, visual analytics, etc., to understand how they can be leveraged.
- Discuss how data can be used through all phases of an investigation.
The Education & Training Committee is particularly interested in presentations that fit into one of the session types below. Topics should be geared toward experienced analysts. Descriptions should summarize the key techniques being described or demonstrated, the data challenge(s) being addressed, and what the participant will take away.
Traditional presentation that describes a data challenge and a solution or methodology for addressing that concern or fraud scheme. This could also be a case study that provides a deep dive on the analytic methods used during the investigation and how to best present this information.
Speaker would use a deidentified or created dataset provided to participants to show participants a strategy to manipulate data, run analysis, graph/visualize data, etc.
Speaker would introduce a topic and then lead the group in a virtual discussion so multiple viewpoints and examples can be heard and discussed.
Schemes for Health Care Fraud Investigators & Analysts
Submission Deadline: February 11
Program Dates: June 21 – July 25
This annual training offers investigators and analysts insights on detecting a variety of schemes through coding, analytics, and other red flags. The goals of this program are to provide participants the opportunity to:
- Hear detailed explanations of how a scheme operates.
- Explore red flags for these schemes, including analytics, coding and/or modifiers, medical records, etc.
- Discuss the nuances of the scheme or specialty area being discussed.
- Examine investigative strategies for a scheme or specialty area.
- Understand how to take this information and apply it to their own claims data and investigations.
The Education & Training Committee is particularly interested in presentations that fit into one of the categories below. Schemes pertaining to commercial health insurance, supplemental insurance, and government programs, especially Medicare, Medicaid, and Medicaid Managed Care, are welcome.
Case Studies & Investigative Strategies
Case study submissions should clearly outline how the case was identified, the role of data in the case, identify the parts of the scheme and corresponding steps of the investigation from beginning to end, explore collaborations and partnerships with other organizations/agencies, and, if applicable, explain relevant steps to preventing future fraud in this area.
Submissions should include a description of methods used to identify/confirm the scheme, how data was used in the investigation, what codes were identified, and what can be replicated in other investigations. When submitting, provide the following information in the description:
- What data techniques were used to find or confirm the scheme?
- Who is the audience for the session – the investigator? analyst?
- What are the codes and/or modifiers identified in this scheme (CPT, ICD-10, HCPCS, REV codes)?
Clinical, Coding, & Chart Review
Submissions in this category should advance an investigator or analyst’s understanding of health care fraud through clinical and/or coding knowledge. Speakers might review a procedure, discuss coding discrepancies, or show how a chart review can be completed. Ideal presenters will hold medical credentials or coding credentials (CPC, CPMA, CPC-H, etc.), as NHCAA would like to provide credit through AAPC for this program.
Enhancing Your Skills: Managing & Navigating Complex Investigations
Submission Deadline: February 25
Program Dates: August 10 – 12
This program is designed to enhance the skills of middle managers and investigators on the rise. Content focuses on the skills necessary for complex investigations. Speakers will utilize case examples to highlight their best practices. The goals of this program are to provide participants the opportunity to:
- Unravel schemes through a focus on case management and development.
- Review how to make decisions using analytics.
- Examine the role of internal collaboration and discuss ways to develop and motivate your investigative team.
- Develop skills experienced anti-fraud professionals need, such as interviewing and negotiation, to conduct effective investigations.
- Explore effective collaboration with law enforcement or government partners.
The Education & Training Committee is particularly interested in presentations that fit into one of the categories below. Schemes and management techniques pertaining to commercial health insurance, supplemental insurance, and government programs, especially Medicare, Medicaid, and Medicaid Managed Care, are welcome.
In your submission description, please detail the case management skills needed to investigate your complex scheme. Sessions should emphasize ways to enhance and refine skills, ideally with examples of improved investigative outcomes, lessons learned, and habits investigators can adopt immediately. For skill-based sessions not reliant upon a scheme, unless the skill is unique, no foundation building sessions (i.e., Level I) will be accepted for presentation.
- Kickback arrangements
- Unique owner arrangements
- Birth tourism / medical tourism
- Direct marketing schemes
- Foreign claims
- Intraoperative neuromonitoring
- Investigative skills
- Managing pre-pay review
- Price Gouging
- Virtual offices
Please review the information below before submitting a presentation idea.
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
- 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.
Sessions should be developed for a level II or III audience and should not include introductory or generic information for common fraud schemes. For emerging or difficult schemes this type of information is acceptable to include.
50-60 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 between five - ten 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.
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 three takeaways for the audience.
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 any relevant industry experience.
Submission Review Process
- The Education & Training Committee, comprised of approximately fifteen representatives from health plans and federal government agencies, will review each submission and determine if it is appropriate for presentation at one of the 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 approximately three months in advance of the program. All submitters will be notified of the committee’s decision on their submission(s).
Below is what NHCAA expects from speakers at our programs and what speakers can expect from the Association.
- Participate in conference calls with NHCAA staff to develop presentation content and discuss program logistics.
- Participate in technology test run.
- Provide a PowerPoint presentation for the participant materials portal at least one week in advance of the program. All speakers, including those from law enforcement, must provide at least a title slide and a slide with the takeaways from the presentation for the portal.
- Rehearse presentation to ensure it fits within allotted time frame.
- Arrive in the virtual meeting room at time specified.
- 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.
- 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 virtual meeting rooms and presentations and assist with any onsite speaking or logistics needs.