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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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Documents
8/5/2020

Recording: Fraud Schemes Case Study: Health Alliance Medical Plans
Health Alliance shares their experience using a systematic, data-based approach to identify fraud schemes and address them in a timely manner.

7/29/2020

Presentation: Fraud Schemes Case Study: Health Alliance Medical Plans
Health Alliance shares their experience using a systematic, data-based approach to identify fraud schemes and address them in a timely manner.

Attendees

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

  • Carrie Abenante
  • ALLIANCE MEMBER
  • Manager, Special Investigations Unit at Sentara Health Plans (Optima)
  • Karen Andersen
  • ALLIANCE MEMBER
  • RN - Clinical Coding Auditor at SelectHealth
  • Robyn Anderson
  • ALLIANCE MEMBER
  • Compliance Analyst at Health Alliance Plan (HAP)
  • Jane Antonio
  • ALLIANCE MEMBER
  • Fraud, Waste and Abuse Investigator at Neighborhood Health Plan of Rhode Island
  • Gay Ball
  • ALLIANCE MEMBER
  • MRA Project Manager, Cone Health at HealthTeam Advantage
  • Tiaura Bliss
  • ALLIANCE MEMBER
  • Compliance Analyst at Care N' Care Insurance Company, Inc.
  • Pat Bremer
  • ALLIANCE MEMBER
  • Supervisor, Special Investigation Unit at Paramount Health Care
  • Michelle Burnham
  • ALLIANCE MEMBER
  • RN, Clinical Auditor at Neighborhood Health Plan of Rhode Island
  • Jolene Carter
  • ALLIANCE MEMBER
  • Certified Medical Review Examiner at CommunityCare
  • Fernando Cedano
  • ALLIANCE MEMBER
  • Business Data Analyst at Alliant Health Plans
  • karla colasacco
  • ALLIANCE MEMBER
  • CPhT at FirstCarolinaCare Insurance Company
  • Kathy Coslett
  • ALLIANCE MEMBER
  • SIU Investigator at Geisinger Health Plan
  • Michele Crissman
  • ALLIANCE MEMBER
  • Director - Compliance and Privacy/Attorney at Avera Health Plans (DAKOTACARE)
  • Corinna Daunt
  • ALLIANCE MEMBER
  • Compliance Investigator at Health Alliance Plan (HAP)
  • Paula Davis
  • ALLIANCE MEMBER
  • Director, Claims Quality at IU Health Plans
  • Keimi Dragovich
  • ALLIANCE MEMBER
  • Manager of Compliance at Community Health Plan of Washington
  • Lisa Dupleich
  • ALLIANCE MEMBER
  • FWA Compliance Specialist at Community Health Plan of Washington
  • Jeremy Fejfar
  • ALLIANCE MEMBER
  • Pharmacy Director Government Programs at Quartz Health Solutions
  • Mary Glasgow
  • ALLIANCE MEMBER
  • Senior Corporate Compliance Analyst at Physicians Health Plan
  • Jill Henrich
  • ALLIANCE MEMBER
  • Investigator at Geisinger Health Plan
  • Elizabeth Heying
  • ALLIANCE MEMBER
  • Manager of Contracts and Compliance at Medical Associates Health Plans
  • Karen Jensen
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment and SIU at Quartz Health Solutions
  • Shannon Kast
  • ALLIANCE MEMBER
  • SIU Analyst at Prominence Health Plan
  • Flora Lewis
  • ALLIANCE MEMBER
  • Sr. Investigative Analyst at Mount Carmel Health Plan (MediGold)
  • Edward McCormick
  • ALLIANCE MEMBER
  • SIU Team Coordinator at Sentara Health Plans (Optima)
  • Jennifer Miller
  • ALLIANCE MEMBER
  • AUDITOR at Neighborhood Health Plan of Rhode Island
  • Tammy Miller
  • ALLIANCE MEMBER
  • Business Analyst at 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 Mount Carmel Health Plan (MediGold)
  • Leslie Pels-Beck
  • ALLIANCE MEMBER
  • Chief Operations Officer at Sharp Health Plan
  • Tenille Perring
  • ALLIANCE MEMBER
  • SIU Analyst at Health Alliance Medical Plans
  • Kristi Peters
  • ALLIANCE MEMBER
  • Process Improvement Coord. at Physicians Health Plan
  • Julie Powell
  • ALLIANCE MEMBER
  • Investigator at Sentara Health Plans (Optima)
  • Teresa Powers
  • ALLIANCE MEMBER
  • Special Investigations Coordinator at Samaritan Health Plans
  • Cindy Ramos
  • ALLIANCE MEMBER
  • Health Care Investigator at MetroPlus Health
  • Dana Renicker
  • ALLIANCE MEMBER
  • Medicare Education Specialist at SummaCare
  • Noreen Rhoades
  • ALLIANCE MEMBER
  • Sr. Claims Reimbursement and Coding Specialist at Community Health Plan of Washington
  • Elizabeth Rich
  • ALLIANCE MEMBER
  • FWA Program Manager at IU Health Plans
  • Melissa Rusk
  • ALLIANCE MEMBER
  • Director, Claims and BPO Operations at SummaCare
  • Lauren Russell
  • ALLIANCE MEMBER
  • Attorney at Scott & White Health Plan
  • Wesley Sanders
  • ALLIANCE MEMBER
  • Vice President, Finance & Analytics at Alliant Health Plans
  • Sarah Schultz
  • ALLIANCE MEMBER
  • Internal Auditor at CommunityCare
  • Dang Tran
  • ALLIANCE MEMBER
  • Clinical Pharmacy Coordinator at Chinese Community Health Plan
  • Egle Urbonaite
  • ALLIANCE MEMBER
  • Compliance Intern at Central Health Plan of California
  • Nadia Vasconcelos
  • ALLIANCE MEMBER
  • SIU Manager at Neighborhood Health Plan of Rhode Island
  • Marie Zerda
  • ALLIANCE MEMBER
  • Corporate Compliance, Privacy and Security Officer at Community Health Plan of Washington
Speakers