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Imitation is the sincerest form of Fraud?

Event Date: 6/1/2023

Event Overview

Thursday, 6/1/2023
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.


  

Documents
6/2/2023

Recording: 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.

6/1/2023

Presentation: Imitation is the sincerest form of Fraud?
Healthcare Fraud Shield walks 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

  • Rachel Barraza
  • ALLIANCE MEMBER
  • Compliance Associate at Care N' Care Insurance Company, Inc.
  • Stephanie Belue
  • ALLIANCE MEMBER
  • Director of Quality Assurance & Privacy Officer at Alliant Health Plans
  • Brit Ben-Zikri
  • ALLIANCE MEMBER
  • SIU Supervisor at Quartz Health Solutions
  • Meagan Canney
  • ALLIANCE MEMBER
  • Audit and Recovery Specialist at Community Health Options
  • Nadine Casey
  • ALLIANCE MEMBER
  • Compliance Consultant - Fraud, Waste and Abuse Program at IU Health Plans
  • Kathy Coslett
  • ALLIANCE MEMBER
  • SIU Manager at Geisinger Health Plan
  • Lisa Denney
  • ALLIANCE MEMBER
  • FWA Supervisor at Johns Hopkins Health Plans
  • Beth Dennis
  • ALLIANCE MEMBER
  • Sr. Financial Auditor at Paramount Health Care
  • Megan Geltman
  • ALLIANCE MEMBER
  • Manager of Compliance Regulatory Oversight at Care N' Care Insurance Company, Inc.
  • Mary Glasgow
  • ALLIANCE MEMBER
  • Senior Corporate Compliance Auditor at Physicians Health Plan
  • Jessica Grenier
  • ALLIANCE MEMBER
  • Director, Claim Operations at Community Health Options
  • Jill Hudspeth
  • ALLIANCE MEMBER
  • Compliance Associate at Care N' Care Insurance Company, Inc.
  • Patricia James
  • ALLIANCE MEMBER
  • SIU Team Coordinator at Sentara Health Plans (Optima)
  • Karen Jensen
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment and SIU at Quartz Health Solutions
  • Shannon Kast
  • ALLIANCE MEMBER
  • PIU Analyst at Prominence Health Plan
  • Gretchen Lagassee
  • ALLIANCE MEMBER
  • Manager, Claims Operations at Community Health Options
  • Lisa Line
  • ALLIANCE MEMBER
  • SIU Investigator at Paramount Health Care
  • Mary McMaster
  • ALLIANCE MEMBER
  • Lead Investigator at CommunityCare
  • Fran McMaster
  • ALLIANCE MEMBER
  • Compliance Consultant at Piedmont Community Health Plan
  • Brandy Morse
  • ALLIANCE MEMBER
  • Director, Risk Adjustment at Ochsner Health Plan
  • Sandra Nary
  • ALLIANCE MEMBER
  • Clinical Auditor at Neighborhood Health Plan of Rhode Island
  • Caryn O'Haire
  • ALLIANCE MEMBER
  • RN Clinical Auditor at Neighborhood Health Plan of Rhode Island
  • Tavonda Parker
  • ALLIANCE MEMBER
  • Director of Utilization Management at HealthTeam Advantage
  • Carol Pawlosky
  • ALLIANCE MEMBER
  • RN, BSN, SIU Program Manager at MediGold
  • Leslie Pels-Beck
  • ALLIANCE MEMBER
  • Chief Operations Officer at Sharp Health Plan
  • Valerie Puig
  • ALLIANCE MEMBER
  • Senior Investigator at Johns Hopkins Health Plans
  • 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
  • Karis Scott
  • ALLIANCE MEMBER
  • Physician Compliance Auditor at Baylor Scott & White Health Plan
  • Deb Sterner
  • ALLIANCE MEMBER
  • Clinical Auditor at Geisinger Health Plan
  • Sing Tam Lee
  • ALLIANCE MEMBER
  • External Audit Investigator at Providence Health Plan
  • Elaine Taylor
  • ALLIANCE MEMBER
  • Compliance Consultant at IU Health Plans
  • Jesse Warner
  • ALLIANCE MEMBER
  • Director of Internal Audit at Network Health
  • John Waugh
  • ALLIANCE MEMBER
  • Director - SIU at Johns Hopkins Health Plans
  • Stephanie Wiegman
  • ALLIANCE MEMBER
  • Customer Experience Coordinator at Samaritan Health Plans
Speakers