Top Schemes of 2025
Each year NHCAA analyzes investigations, industry intelligence, and insights from our committees and leaders to identify the top fraud schemes impacting the industry.
For 2025, three areas rose to the top: skin substitutes, phantom providers, and home health. Schemes that reflect both the persistence of traditional fraud and the increasing sophistication of today’s threat landscape.
In this session, our speakers go beyond these headline schemes to explore what they are seeing in the field right now. Drawing on recent case experience, they examine how familiar fraud models continue to re-emerge with new twists, including phantom providers, tissue-engineered skin substitutes, acupuncture misrepresentation, cardiovascular testing of student athletes, direct member reimbursement (DMR) fraud, and home health billing schemes.
Participants will gain practical insight into how these schemes operate today, including common red flags, documentation deficiencies, and billing patterns, along with the investigative strategies used to detect and mitigate them. The session emphasizes proactive identification, leveraging data analysis, strengthening provider validation, and enhancing cross-team collaboration to reduce exposure.
Learning Objectives
After completing this training, participants will be able to:
- Recognize key indicators of emerging and re‑emerging healthcare fraud schemes, including phantom providers, skin substitute billing, alternative medicine services, and home health fraud.
- Identify common documentation, billing, and behavioral red flags that signal potential fraud, waste, or abuse, such as misrepresentation of services, services not rendered, inflated units, and altered or fabricated records.
- Apply investigative best practices—including data analysis, record review, public records research, and member outreach—to support early detection, effective case development, and loss prevention.
Speakers:
Sean Petree, AHFI
Fraud Senior Manager, Special Investigations Unit
Cigna/Evernorth
Briana Hollenbeck, MS, AHFI, CPC, CFE
Fraud Senior Manager, Case Development
Cigna/Evernorth
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
| April 6 – 30, 2026 | After April 30, 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.
Our FAQ website will be available soon. Registration and login questions can go to training@nhcaa.org. Questions about content or NHCAA Learn functionality can be directed to learn@nhcaa.org.
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
