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Fraud Schemes Case Study: Health Alliance Medical Plans-So Now What?
Event Date: 7/29/2020
Event Overview
Wednesday, 7/29/2020
1:00 PM CT – 2:00 PM CT (60 minutes)
Hosted by: Health Alliance Medical Plans
NOTE: You will receive login information from Health Plan Alliance - webinar.host@bigmarker.com if you do not receive an email confirmation contact our Support team at 888.472.0123
Fraudulent billing in healthcare is a huge issue for health plans and provider organizations and can be extremely costly. A systematic, data-based approach is required to identify fraud schemes and address them in a timely manner. Consider these scenarios: A fraud, waste and/or abuse lead is received or a referral is submitted, or a new fraud scheme is shared with the Special Investigations Unit (SIU). One of the first steps should include a basic exposure check - but a deeper dive into claims data is integral to a successful investigation. Without understanding the claims data, analysts and investigators expend time and effort unnecessarily. This webinar will walk through Health Alliance's approach and strategies that have enabled its SIU to efficiently identify and prioritize investigations in order to combat FWA. This webinar will include the following:
- Excel formulas and functions
- Access queries: Exposure, Averages and Counts
- Date of service ranges
- Outlier analysis for FWA schemes
Audience
Fraud, waste and abuse team members and those involved in their health plan’s SIU. Legal, IT, claims management, provider relations, and compliance managers will also find this session beneficial.
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Attendees
Below is a list of all delegates registered to date for this event
- Carrie Abenante
- ALLIANCE MEMBER
- Director, Special Investigations Unit at Sentara Health Plans
- Robyn Anderson
- ALLIANCE MEMBER
- Delegation Oversight Auditor at Health Alliance Plan (HAP)
- Tiaura Bliss
- ALLIANCE MEMBER
- Compliance Analyst at Care N' Care Insurance Company, Inc.
- Karla Colasacco
- ALLIANCE MEMBER
- CPhT at FirstCarolinaCare Insurance Company
- Kathy Coslett
- ALLIANCE MEMBER
- SIU Manager at Geisinger Health Plan
- Michele Crissman
- ALLIANCE MEMBER
- Attorney at Avera Health Plans
- Kaitlyn Daigle
- ALLIANCE MEMBER
- Risk Adjustment Coding Auditor at Health New England
- Corinna Daunt
- ALLIANCE MEMBER
- Product Consultant at Health Alliance Plan (HAP)
- Jeremy Fejfar
- ALLIANCE MEMBER
- Pharmacy Director Government Programs at Quartz Health Solutions
- Mary Glasgow
- ALLIANCE MEMBER
- Senior Corporate Compliance Auditor at University of Michigan Health Plan
- Elizabeth Heying
- ALLIANCE MEMBER
- Counsel & Compliance Manager at Medical Associates Health Plans
- Karen Jensen
- ALLIANCE MEMBER
- Manager, Risk Adjustment and SIU at Quartz Health Solutions
- Charles Joujoute
- ALLIANCE MEMBER
- Director of Medicare Sales & Retention at Health Alliance Medical Plans
- Shannon Kast
- ALLIANCE MEMBER
- PIU Analyst at Prominence Health Plan
- Flora Lewis
- ALLIANCE MEMBER
- Program Manager at MediGold
- Edward McCormick
- ALLIANCE MEMBER
- SIU Team Coordinator at Sentara Health Plans
- Tammy Miller
- ALLIANCE MEMBER
- Business Analyst at Baylor Scott and White Health Plan
- Jennifer Miller
- ALLIANCE MEMBER
- AUDITOR at Neighborhood Health Plan of Rhode Island
- 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
- Julie Powell
- ALLIANCE MEMBER
- Sr. Investigator at Sentara Health Plans
- 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
- Noreen Rhoades
- ALLIANCE MEMBER
- Program Integrity Manager at Community Health Plan of Washington
- Melissa Rusk
- ALLIANCE MEMBER
- Vice President Operations at SummaCare
- Anthony Serrano
- ALLIANCE MEMBER
- Compliance Officer at Aspire Health Plan
- Marie Zerda
- ALLIANCE MEMBER
- VP, Compliance Officer at Community Health Plan of Washington