Pharmacy Case Study
Compound Fraud Scheme Migrates to Wound Management
*Registration opens July 7, 2026.
This case study examines an emerging pharmacy fraud, waste, and abuse (FWA) scheme involving compounded wound management therapies billed through the pharmacy benefit. Using a real-world investigation, faculty demonstrate how data analytics, pharmacy and medical claims review, clinical assessment, and investigative techniques were combined to identify suspicious prescribing patterns, validate potential fraud, and support remediation efforts.
Participants will learn how investigators recognized unusual utilization trends, evaluated relationships among pharmacies, prescribers, and members, incorporated evidence-based clinical research into their review, and conducted investigative activities such as documentation review and member interviews. The presentation also highlights practical strategies for identifying similar schemes and translating clinical findings into defensible investigative outcomes.
Learning Objectives
- Identify data analytics and claims-based indicators associated with compounded wound management pharmacy FWA.
- Apply investigative techniques—including integrated pharmacy and medical claims analysis, documentation review, and member interviews—to evaluate suspected pharmacy fraud schemes.
- Evaluate the clinical appropriateness of compounded wound management therapies using evidence-based resources to distinguish legitimate treatment from potential fraud, waste, and abuse.
Speakers
Casey Jenness, PharmD, MBA
Director, FWA Clinical Support Services
Prime Therapeutics
Jared Mendoza Duenas, RN, PHN, AHFI, CPhT
Director, Special Investigations Unit
Prime Therapeutics
Registration Information
Employees of NHCAA Member Organizations, Government Liaisons, Supporting Members, and Individual Members can register online for NHCAA Monthly On-Demand trainings. A registration form is not available, you must login as a member to register. If you are having issues logging in or registering, please contact training@nhcaa.org.
Non-members, including local, state, and federal public agencies who are not NHCAA Government Liaisons, do not have access to NHCAA Monthly On-Demand trainings.
REGISTRATION RATES
| July 7 – 31, 2026 | After July 31, 2026 | |
| NHCAA Member Organizations1 | Complimentary | Complimentary |
| NHCAA Government Liaisons2 | Complimentary | $50 |
| Individual Members3 | $50 | $50 |
REGISTRATION POLICIES
Complimentary registration closes on the last day of the month. Paid registration is open after the complimentary time-period ends. The registration period for complimentary registrations will end at 11:59 pm Pacific Time.
Cancellation/Substitution
All cancellations (regardless of date) will be assessed with a $10 administrative fee.
All written notice of cancellations and substitutions should be sent via email to training@nhcaa.org. Cancellations received within 5 days of the date of purchase will result in a refund minus an administrative fee if the training has not occurred. No refunds will be issued if any portion of the Monthly On-Demand program has been viewed. Registrations are non-transferrable for webinars.
Concerns
For more information regarding administrative policies such as refunds, cancellations and complaints, please email training@nhcaa.org.
Details & Frequently Asked Questions
Monthly On-Demand trainings are most appropriate for beginning and mid-career analysts, investigators, consultants, and law enforcement agents working in the health care anti-fraud industry.
As a level II, or intermediate program, some investigative / health care / coding expertise is assumed. Training content is focused on the detection and investigative processes, using case examples to highlight strategy and techniques.
There are no pre-requisite requirements to attend the Monthly On-Demand trainings.
All Monthly On-Demand trainings are approved by: NHCAA for 1 CPE
Participants earn 1 Continuing Professional Education (CPE) hours applicable to the training requirements for the Accredited Health Care Fraud Investigator (AHFI®) designation.Monthly On-Demand trainings are delivered via NHCAA Learn. You will need a good internet connection and an up-to-date version of Chrome, Firefox, Edge, or Safari. Internet Explorer is not recommended and will not render content correctly.
Video content will open in a pop-up window. You may need to disable a pop-up blocker.
1Member Rate applies to all NHCAA Member Organizations, Affiliate Members, and Platinum Supporting, Premier Supporting and Supporting Members.
2Government Liaison Rate applies to employees of NHCAA Government Liaisons only.
3 Individual Member Rate applies to individuals that have applied for and been approved for individual membership and whose membership dues are current.
- CPEs: 1
