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Imitation is the sincerest form of Fraud?

Event Date: 3/15/2023

Event Overview

Wednesday, 3/15/2023
11:00 AM CT – 12:00 PM CT (60 minutes)
Vendor Spotlight Host: Healthcare Fraud Shield

This session will walk attendees through the uncovering of a case of billing for services not rendered, using the emergency room for non-emergent services and impersonation in the hopes of pushing payments along. We'll review an actual case that resulted in hundreds of millions of dollars paid out inappropriately and the trail of evidence left behind.

1) Learn how to identify this type of scheme in your data
2) Review internal systems and resources that can be integral to your investigation
3) Discuss the the best types of analytics to detect these schemes
4) Review data mining techniques to further validate findings

 

Notice to Participants:
Please note that this webinar is a Vendor Spotlight and will be a capabilities-focused presentation. While this vendor is not under contract with the Health Plan Alliance, we believe this webinar will provide you the opportunity to learn more about this vendor and the programs and services it provides. Offering this webinar does not imply that the Health Plan Alliance endorses this vendor. The webinar is merely for informational purposes only. Should you wish to share feedback and/or have questions about this vendor, please contact Jaime González, the Alliance’s Chief Business Development Officer, at jaime.gonzalez@healthplanalliance.org or 972-830-6355.


 

Thank you to our event sponsors


Silver

 

Documents
3/6/2023

Presentation: Imitation is the sincerest form of Fraud?
Healthcare Fraud Shield will walk attendees through the uncovering of a case of billing for services not rendered, using the emergency room for non-emergent services and impersonation in the hopes of pushing payments along.

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)
  • Tiffany Amos
  • ALLIANCE MEMBER
  • Clinical Coding Nurse Analyst at Johns Hopkins Health Plans
  • Robyn Anderson
  • ALLIANCE MEMBER
  • Delegation Oversight Auditor at Health Alliance Plan (HAP)
  • Elizabeth Bailey
  • ALLIANCE MEMBER
  • Physician Compliance Auditor at Baylor Scott & White Health Plan
  • Michael Baumann
  • ALLIANCE MEMBER
  • Director of Compliance at Baylor Scott & White Health Plan
  • Tiaura Bliss
  • ALLIANCE MEMBER
  • Compliance Analyst at Care N' Care Insurance Company, Inc.
  • Nadine Casey
  • ALLIANCE MEMBER
  • Compliance Consultant - Fraud, Waste and Abuse Program at IU Health Plans
  • Dinita Galvez
  • ALLIANCE MEMBER
  • Quality Improvement Manager at Health Alliance Medical Plans
  • Mary Glasgow
  • ALLIANCE MEMBER
  • Senior Corporate Compliance Auditor at Physicians Health Plan
  • Christine Grothen
  • ALLIANCE MEMBER
  • External Audit Investigator - SIU at Providence Health Plan
  • Melissa Horgan
  • ALLIANCE MEMBER
  • FWA Investigator at Neighborhood Health Plan of Rhode Island
  • Julie Hoskins
  • ALLIANCE MEMBER
  • Manager, Quality Improvement at Paramount Health Care
  • Karen Jensen
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment and SIU at Quartz Health Solutions
  • Shannon Kast
  • ALLIANCE MEMBER
  • PIU Analyst at Prominence Health Plan
  • Joby Kolsun
  • ALLIANCE MEMBER
  • medical director at AvMed
  • Lisa Line
  • ALLIANCE MEMBER
  • SIU Investigator at Paramount Health Care
  • Mary McMaster
  • ALLIANCE MEMBER
  • Lead Investigator at CommunityCare
  • Caryn O'Haire
  • ALLIANCE MEMBER
  • RN Clinical Auditor at Neighborhood Health Plan of Rhode Island
  • Carol Pawlosky
  • ALLIANCE MEMBER
  • RN, BSN, SIU Program Manager at MediGold
  • Cindy Ramos
  • ALLIANCE MEMBER
  • Health Care Investigator at MetroPlusHealth
  • SHARON ROBERSON
  • ALLIANCE MEMBER
  • Sr. PREPAYMENT AUDITOR at Providence Health Plan
  • Melissa Rusk
  • ALLIANCE MEMBER
  • Vice President Operations at SummaCare
  • Emily Schultz
  • ALLIANCE MEMBER
  • Medical Auditor at Physicians Health Plan
  • Sherie Simmons
  • ALLIANCE MEMBER
  • Manager MAHP Claims at Medical Associates Health Plans
  • Loan Stackhouse
  • ALLIANCE MEMBER
  • Coding at Community Health Plan of Washington
  • Lacy Ware
  • ALLIANCE MEMBER
  • Director of Health Care Improvement at Baylor Scott & White Health Plan
Speakers