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FWA Policies and Procedures: Discovering Best Practices

Event Date: 5/27/2020

Event Overview

Wednesday, 5/27/2020
1:00 PM CT – 2:00 PM CT (60 minutes)
Hosted by: IU Health Plans & Mount Carmel

This event is hosted on our BigMarker platform

 

Join us to participate in an exchange of SIU best practices.  Hear how two Alliance member health plans have successfully developed policies and procedures to detect and prevent costly fraud, waste and abuse.  In addition to covering processes used for detection and measures to take for prevention, you will learn about:

•        The difference between policy and procedure

•        Setting standards

•        Determining what policies you absolutely have to have

•        Policy and procedure template use and examples

•        Storage and review of policies and procedures


 

Audience

Those responsible for managing fraud, waste and abuse detection and reporting activities and conducting special investigations. Those overseeing legal and compliance implications of fraudulent activity will also have an interest in attending.

 

Ask your peers a question or share a resource anytime through the Alliance discussion forum

You can visit the discussion forum and post a question anytime. It's only available to Alliance members, so you question is private and secure. When submitting a question, you can select which topics your question is related to. Individuals who have indicated in their Alliance profile they are interested in those topics and are opted in to discussion forum emails will receive your question. You can also add an attachment to your question or reply, making this tool another great resource for sharing best practices with your peers.

 

 

 

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Documents
5/27/2020

Recording: FWA Policies and Procedures: Discovering Best Practices
IU Health Plans and Mount Carmel share how their fraud, waste, and abuse policies and procedures work for them to protect their organizations. Hear about setting standards, identifying "must have" policies, examples of templates used, and policy storage and review practices.

5/25/2020

Health Alliance Plan_Policy Template
Health Alliance Plan provides their policy template for alliance members.

Attendees

Below is a list of all delegates registered to date for this event

  • Mike Abdo
  • ALLIANCE MEMBER
  • Director of Pharmacy at CommunityCare
  • Faith Achenbach
  • ALLIANCE MEMBER
  • Physician Compliance Auditor II at Baylor Scott & White Health
  • Trisha Adams
  • ALLIANCE MEMBER
  • Director, Member Services at Physicians Health Plan
  • Robyn Anderson
  • ALLIANCE MEMBER
  • Delegation Oversight Auditor at Health Alliance Plan (HAP)
  • Tamara Avery
  • ALLIANCE MEMBER
  • Supervisor Medical Review at CommunityCare
  • Ann Bain
  • ALLIANCE MEMBER
  • Compliance Coordinator & Privacy Officer at Avera Health Plans
  • Michael Baumann
  • ALLIANCE MEMBER
  • Director of Compliance at Baylor Scott & White Health Plan
  • Stephanie Belue
  • ALLIANCE MEMBER
  • Director of Quality Assurance & Privacy Officer at Alliant Health Plans
  • Tiaura Bliss
  • ALLIANCE MEMBER
  • Compliance Analyst at Care N' Care Insurance Company, Inc.
  • Bill Bradish
  • ALLIANCE MEMBER
  • Manager-SIU at Presbyterian Health Plan
  • Pat Bremer
  • ALLIANCE MEMBER
  • Supervisor, Special Investigation Unit at Paramount Health Care
  • Karen Brunton
  • ALLIANCE MEMBER
  • Project Manager at Medical Associates Health Plans
  • Kevin Chi
  • ALLIANCE MEMBER
  • Assistant Compliance Counsel at Central Health Plan of California
  • Karla Colasacco
  • ALLIANCE MEMBER
  • CPhT at FirstCarolinaCare Insurance Company
  • Amy Cornett
  • ALLIANCE MEMBER
  • VP, Compliance at Baylor Scott & White Health Plan
  • Kathy Coslett
  • ALLIANCE MEMBER
  • SIU Manager at Geisinger Health Plan
  • Corinna Daunt
  • ALLIANCE MEMBER
  • Product Consultant at Health Alliance Plan (HAP)
  • Nicole Davanzo
  • ALLIANCE MEMBER
  • Director, Payment Integrity at Health First Health Plans
  • Crystal Djordjevic
  • ALLIANCE MEMBER
  • Risk Adjustment Education Specialist at Health Alliance Medical Plans
  • Marisa Ellis
  • ALLIANCE MEMBER
  • Senior Compliance Partner II at SelectHealth
  • Michelle Faniola
  • ALLIANCE MEMBER
  • Program Integrity Investigator III at Presbyterian Health Plan
  • Kelly Faust
  • ALLIANCE MEMBER
  • Pharmacist at Geisinger Health Plan
  • Jeremy Fejfar
  • ALLIANCE MEMBER
  • Pharmacy Director Government Programs at Quartz Health Solutions
  • Mary Glasgow
  • ALLIANCE MEMBER
  • Senior Corporate Compliance Auditor at Physicians Health Plan
  • Trissi Gray
  • ALLIANCE MEMBER
  • Director of Compliance, SWHR at Southwestern Health Resources
  • Jessica Grenier
  • ALLIANCE MEMBER
  • Director, Claim Operations at Community Health Options
  • Holli Hansen
  • ALLIANCE MEMBER
  • Contracting Analyst at Avera Health Plans
  • Jill Henrich
  • ALLIANCE MEMBER
  • Investigator at Geisinger Health Plan
  • Elizabeth Heying
  • ALLIANCE MEMBER
  • Counsel & Compliance Manager at Medical Associates Health Plans
  • Tracy Jones
  • ALLIANCE MEMBER
  • Chief Compliance Officer at SummaCare
  • Shannon Kast
  • ALLIANCE MEMBER
  • PIU Analyst at Prominence Health Plan
  • Erin Kavanagh
  • ALLIANCE MEMBER
  • Risk Adjustment Analyst at Samaritan Health Plans
  • Ashley Kim
  • ALLIANCE MEMBER
  • assistant compliance counsel at Central Health Plan of California
  • Susan Leitzell
  • ALLIANCE MEMBER
  • Lead Fraud Investigator at Geisinger Health Plan
  • Guoyi Liu
  • ALLIANCE MEMBER
  • Risk Adjustment Analyst at Santa Clara Family Health Plan
  • Cindy Macdonald
  • ALLIANCE MEMBER
  • Audit and Recovery Specialist at Community Health Options
  • Tammy Miller
  • ALLIANCE MEMBER
  • Business Analyst at Baylor Scott & White Health Plan
  • Jaquelynn Mokry
  • ALLIANCE MEMBER
  • Physician Compliance Auditor at Baylor Scott & White Health Plan
  • Sandra Nary
  • ALLIANCE MEMBER
  • Clinical Auditor at Neighborhood Health Plan of Rhode Island
  • Wendy Owen
  • ALLIANCE MEMBER
  • Sr. Fraud & Abuse Investigator at Sentara Health Plans (Optima)
  • Carol Pawlosky
  • ALLIANCE MEMBER
  • RN, BSN, SIU Program Manager at MediGold
  • Leslie Pels-Beck
  • ALLIANCE MEMBER
  • Chief Operations Officer at Sharp Health Plan
  • Victoria Phan
  • ALLIANCE MEMBER
  • Chief Opearating Officer at Valley Health Plan
  • Julie Powell
  • ALLIANCE MEMBER
  • Investigator at Sentara Health Plans (Optima)
  • Teresa Powers
  • ALLIANCE MEMBER
  • SIU Analyst - Special Investigations Coordinator at Samaritan Health Plans
  • Cindy Ramos
  • ALLIANCE MEMBER
  • Health Care Investigator at MetroPlusHealth
  • Dana Renicker
  • ALLIANCE MEMBER
  • Medicare Education Specialist at SummaCare
  • Melissa Rusk
  • ALLIANCE MEMBER
  • Vice President Operations at SummaCare
  • Kelly Skifton
  • ALLIANCE MEMBER
  • Assistant Vice President, Compliance & Government Regulatory Operations and Privacy at Quartz Health Solutions
  • Jeanne Skinner
  • ALLIANCE MEMBER
  • Manager, Appeals & Grievance at Network Health
  • Caryn Smith
  • ALLIANCE MEMBER
  • Director of Risk Adjustment at HealthTeam Advantage
  • Jill Stone
  • ALLIANCE MEMBER
  • Health Plan Pharmacist at Geisinger Health Plan
  • Jill Thomas
  • ALLIANCE MEMBER
  • Clincal Auditor at Geisinger Health Plan
  • James Troyer
  • ALLIANCE MEMBER
  • Director of Medical Management at Alliant Health Plans
Speakers