2015 Annual Training Conference & Anti-Fraud Expo

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Sessions (0)

NHCAA Opening General Session (Room Seaport D-H)

18 Nov 15
8:00 AM - 9:00 AM
Speaker(s): Timothy Delaney
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Addressing Evolving Threats in Fraud, Waste and Abuse (Room Seaport A)

18 Nov 15
9:15 AM - 10:15 AM

Tracks: Anti-Fraud Technology Solution

Speaker(s): David Nelson ; Mark Gillespie ; Zachery Charlson
Fraud schemes are continuing to evolve at a staggering rate and the growing Medicaid managed care environment is presenting unique risks for fraud,... More...

CANCELLED: Medicare Risk Adjustment Fraud (Room Coronado A)

18 Nov 15
9:15 AM - 10:15 AM

Tracks: Legal, Management & Compliance Issues, Management Path

Risk Adjustment fraud schemes are no longer just about selecting and enrolling healthy members (false enrollment schemes). False documentation prac... More...

DOJ Update (Room Grand D)

18 Nov 15
9:15 AM - 10:15 AM

Tracks: Law Enforcement Path, Legal, Management & Compliance Issues

Speaker(s): Gejaa Gobena, JD
Faculty will discuss DOJ's fraud fighting initiatives and successes, and how to effectively collect and demonstrate evidence to assist in successfu... More...

Emerging Threats: Pharmaceuticals (Room Seaport C)

18 Nov 15
9:15 AM - 10:15 AM

Tracks: Law Enforcement Path, Pharmacy & Part D Fraud

Speaker(s): Michael Cohen, DHSc, JD, PA-C ; Shimon Richmond
Join two seasoned OIG agents as they examine today's emerging and newly approved drugs and how these drugs may be the focus of tomorrow's i... More...

Foreign Dental Claims & Schemes (Room Coronado D)

18 Nov 15
9:15 AM - 10:15 AM

Tracks: Detecting and Investigating Dental Fraud

Speaker(s): Joaquin Basauri ; Julie Heit
Dental fraud is not unique to the U.S., and cross-border fraud schemes are becoming increasingly more prevalent. Investigators will share first han... More...

Investigating Medicaid Fraud: The Health Plan Perspective (Room Coronado B)

18 Nov 15
9:15 AM - 10:15 AM

Tracks: AHFI Path, Fraud in Medicaid Program

Speaker(s): Briana Hollenbeck, CPC, MS, AHFI ; Janine Kumanchik, AHFI, HCAFA ; Tina Sinclair, CPC, AHFI
Investigating Medicaid fraud can be infinitely more complex due to more stringent regulations, rules differing vastly between states, and a populat... More...

SIU Best Practices Panel (Room Balboa A-C)

18 Nov 15
9:15 AM - 10:15 AM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Erin Picton, AHFI ; Jala Attia, MBA, AHFI, CFE ; Jessica Gay, CPC, AHFI ; Mark Starinsky, AHFI, CFE
Participants will benefit from learning best practices that have demonstrably improved the effectiveness of an SIU and the quality of its investiga... More...

Urine Drug Screens: CPT Coding Update (Room Gaslamp A-D)

18 Nov 15
9:15 AM - 10:15 AM

Tracks: Clinical Issues for the Health Care Fraud Investigator

Speaker(s): Carl Reinhardt, AHFI, CPC ; Janet Bonham, AHFI ; Priscilla Alfaro, MD
This workshop will look at the morphing of urine drug screens from 80101/80104 to the quantitative testing of the urine specimen. Faculty will exam... More...

An Ambulance Fraud Case Study (Room Coronado A)

18 Nov 15
11:00 AM - 12:00 PM

Tracks: Fraud in Medicaid Program, Law Enforcement Path

Speaker(s): Michael Wysocki, CPA ; Stormy Kelly
The presentation will focus on a multifaceted investigation involving ambulance service providers and habilitation therapy centers. Investigators u... More...

Applied Behavior Analysis (ABA) Services (Room Coronado D)

18 Nov 15
11:00 AM - 12:00 PM

Tracks: Behavioral Health Fraud Schemes

Speaker(s): Margaret Payne
The session begins with an overview of the ABA benefit and the services included in the benefit. Through samples of case investigations faculty wil... More...

Dental Coding Schemes (Room Coronado B)

18 Nov 15
11:00 AM - 12:00 PM

Tracks: AHFI Path, Detecting and Investigating Dental Fraud

Speaker(s): Kimberly Brown, RDH, AHFI ; Suzette Long, RDH, AHFI ; Trish M. Shifflett, RDH, AHFI
A panel of dental hygienist fraud investigators examines a variety CDT and CPT dental coding schemes and provide tips for data mining to reduce exp... More...

Freestanding Emergency Centers (Room Seaport A)

18 Nov 15
11:00 AM - 12:00 PM

Tracks: Fraud Schemes and Investigative Skills

Speaker(s): Kenneth Cole, AHFI, CFE, CPC
In recent years, hospitals have moved some traditionally hospital-based healthcare services out of the hospitals to external entities. One of these... More...

How A Multi-pronged Approach and Use of Visualization is Most Effective to Reduce False Positives and Maximize FWA Initiatives (Room Gaslamp A-D)

18 Nov 15
11:00 AM - 12:00 PM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Brad Vinson, CPC-P ; Louise Dobbe, Esq
Learn how a multi-pronged approach is more effective in identifying potential FWA cases. This includes analytics with multi-plan data sets, complex... More...

Marketing Schemes: Compounding Pharmacies (Room Grand D)

18 Nov 15
11:00 AM - 12:00 PM

Tracks: Law Enforcement Path, Pharmacy & Part D Fraud

Speaker(s): Ian Ives
This workshop will address a serious trend emerging in the area of compounding pharmacies - namely the substantial increase in prescriptions for so... More...

NCCI Edit Development: Integrating Data Analysis, Clinical Information, Payment Policy and Claims Processing (Room Seaport B)

18 Nov 15
11:00 AM - 12:00 PM

Tracks: Management Path, Transformation of Health Care

Speaker(s): Daniel Duvall, MD
This lecture will present an overview of the use of automated edits as tools in the prevention of fraud, waste and abuse. Using lessons learned fro... More...

Six Degrees of Separation: Fueling investigations with insight into hidden and complex relationships, associations, and affiliations (Room Balboa A-C)

18 Nov 15
11:00 AM - 12:00 PM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Mark Isbitts
Health care costs continue to rise, affecting everyone involved -- patients, providers, insurance companies and other organizations. While many eff... More...

Social Media and Investigations (Room Seaport C)

18 Nov 15
11:00 AM - 12:00 PM

Tracks: Disability, Workers' Compensation & Supplemental Insurance Product

Speaker(s): Jason Caroluzzi
Faculty will evaluate web-based information of value to an investigation. Topics discussed include the ethics and laws governing the use of social ... More...

Accountable Care Organizations & the Fraud Impact (Room Seaport A)

18 Nov 15
2:15 PM - 3:15 PM

Tracks: Management Path, Transformation of Health Care

Speaker(s): James McCall, AHFI
The presenter will provide a legal overview of Accountable Care Organizations (ACOs), to include a review of what they are, the objectives, how the... More...

Clinical Trial Billing Compliance (Room Gaslamp A-D)

18 Nov 15
2:15 PM - 3:15 PM

Tracks: Clinical Issues for the Health Care Fraud Investigator

Speaker(s): Cindy Parman CPC, CPC-H, RCC
Two modifiers, one diagnosis code and a requirement to supply the clinical trial number make coding services associated with clinical trials a chal... More...

CMS Program Integrity Update (Room Grand D)

18 Nov 15
2:15 PM - 3:15 PM

Tracks: Legal, Management & Compliance Issues

Speaker(s): Jonathan Morse
CMS' leadership will discuss recent health care fraud detection and prevention activities and progress on ground-breaking information sharing initi... More...

Forensic Accounting in Health Care Fraud Investigations (Room Coronado D)

18 Nov 15
2:15 PM - 3:15 PM

Tracks: Fraud Schemes and Investigative Skills

Speaker(s): Emily Foss, MBA, MAcc, CFE
Health care fraud is a form of white collar crime that is on the rise and costing billions of dollars in the United States. Forensic Accountants ar... More...

Medical Identity Theft Panel (Room Seaport B)

18 Nov 15
2:15 PM - 3:15 PM

Tracks: Fraud Schemes and Investigative Skills, Law Enforcement Path

Speaker(s): Jean Stone ; Joseph Popillo, AHFI, CPCO, CPC-A ; Jutta Williams, CISSP, CIPP, CISA
As the health care industry continues to change, identity theft serves as the root to many channels used in perpetuating health care fraud. Faculty... More...

Member & Agent Fraud Schemes in Supplemental Insurance (Room Coronado A)

18 Nov 15
2:15 PM - 3:15 PM

Tracks: Disability, Workers' Compensation & Supplemental Insurance Product

Speaker(s): Jennifer Sample, AHFI ; Ronnie Rahe, AHFI
The presenters will review and discuss in detail current member and agent fraud schemes experienced in supplemental insurance. This will include cl... More...

Part D Vulnerabilities: A Case Study (Room Seaport C)

18 Nov 15
2:15 PM - 3:15 PM

Tracks: Law Enforcement Path, Pharmacy & Part D Fraud

Speaker(s): Chris Dunkle
Faculty will present a case study of a Part D fraud scheme that originated in California, and migrated to Louisiana and Kentucky. The scheme incorp... More...

The Power of Collaboration in the Fight Against Fraud (Room Balboa A-C)

18 Nov 15
2:15 PM - 3:15 PM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Daniel Kreitman ; Dante Robinson ; Doug Coombs
Medical fraud, waste, and abuse (FWA) is estimated to cost the U.S. healthcare system approximately $900 Billion each year-nearly 34 percent of the... More...

Counterfeit Pharmaceuticals (Room Seaport B)

18 Nov 15
3:25 PM - 4:25 PM

Tracks: Pharmacy & Part D Fraud

Speaker(s): Shane Tiernan, AHFI
Counterfeit medicines are found everywhere in the world. They range from random mixtures of harmful toxic substances to inactive, ineffective prepa... More...

Demystifying Oral and Maxillofacial Surgery: Extractions, Impactions, Anesthesia, Sleep Apnea Appliances, and Billing (Room Coronado B)

18 Nov 15
3:25 PM - 4:25 PM

Tracks: Detecting and Investigating Dental Fraud

Speaker(s): David Rubin, DDS
Many dental providers - from general dentists to oral and maxillofacial surgeons - are upcoding simple extractions to surgical extractions. Provide... More...

EHRs and the Fraud Potential (Room Seaport A)

18 Nov 15
3:25 PM - 4:25 PM

Tracks: Management Path, Transformation of Health Care

Speaker(s): Reed D. Gelzer, MD, MPH
Electronic Health Records Systems (EHRs) are now used by the majority of practicing clinicians and hospitals. Currently, however, since there are n... More...

Expanding Beyond Facility RAC Audits with Adaptive Predictive Analytics (Room Balboa A-C)

18 Nov 15
3:25 PM - 4:25 PM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Allyn Pon ; Mike Sawyer
Determining the optimal program integrity strategy for facility claims is an ongoing challenge for most healthcare payer organizations. The complex... More...

Freestanding Behavioral Health Clinics (Room Coronado D)

18 Nov 15
3:25 PM - 4:25 PM

Tracks: Behavioral Health Fraud Schemes

Speaker(s): Amanda Brown, AHFI ; Jill Carraher, LMSW, AHFI
Explore different staff licensures and scopes of practice within free standing behavioral health facilities. Understand treatment frequencies and w... More...

Maximizing Witness Value during Patient and Provider Interviews (Room Coronado A)

18 Nov 15
3:25 PM - 4:25 PM

Tracks: Disability, Workers' Compensation & Supplemental Insurance Product

Speaker(s): Brent Walker, AHFI ; Mitchell Sherrod, AHFI
Through examples and role playing faculty will demonstrate how to approach the patient or provider, the need (and strategies) to obtain evidentiary... More...

SIRIS Investigation of the Year (Room Seaport C)

18 Nov 15
3:25 PM - 4:25 PM

Tracks: Fraud Schemes and Investigative Skills

Hear how a SIRIS lead led to an award winning investigation. NHCAA unveils a new award for investigations that were either discovered or significan... More...

Understanding Pharmacy Operations - A Key for Investigators (Room Gaslamp A-D)

18 Nov 15
3:25 PM - 4:25 PM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Casey H. Chandler ; Joshua Peters, PharmD, RPh
Understanding the daily operations of a typical pharmacy, and the regulations governing pharmacy practice can give investigators deeper insight to ... More...