2015 Annual Training Conference & Anti-Fraud Expo

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Sessions (0)

Alternative Payment Models – Vulnerable or not? (Room Balboa ABC)

19 Nov 15
7:00 AM - 8:00 AM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Timothy Burrell, MD, MBA
With the unprecedented number of Alternative Payment Models being designed by the Centers for Medicare and Medicaid Services and its Innovation Cen... More...

Key tenets of a successful FWA partnership between Medicaid and Federal Law Enforcement: A case study on how to exponentially increase anti-fraud productivity (Room Gaslamp CD)

19 Nov 15
7:00 AM - 8:00 AM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Brian Fisher ; Jacob Schunk
The presenters will discuss examples of how a Medicaid Program Integrity unit has provided highly-valuable case leads and analytical support to law... More...

Pharmacy Claims Advanced Data Analytics (Room Seaport A)

19 Nov 15
7:00 AM - 8:00 AM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Rena Bielinski, PharmD, AHFI ; Rodger Smith, Jr
Specialty drug spending saw a record increase in 2014. Advanced analytics can reduce costs for PBMs and Health Plans alike. Topics of discussion wi... More...

Predictive Analytics is more than just an industry buzzword and the distinction matters to SIUs (Room Old Town AB)

19 Nov 15
7:00 AM - 8:00 AM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Richard Graham ; William Palmisano, III, AHFI, CFE, CSPO
Even as more and more controls are put in place to stop fraud, waste, and abuse, the problem gets larger every year. This coupled with limited reso... More...

The Power of Pooled Data (Room Gaslamp AB)

19 Nov 15
7:00 AM - 8:00 AM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Alanna Lavelle, MS, CPC, AHFI ; Amber Fee RN, BS, AHFI, CPC ; Andrew Dziewulski
This session will discuss how pooling healthcare data can reveal emerging fraud trends, inform instances of patient harm and create collaborative c... More...

10 Legal Issues to Watch (Room Seaport G)

19 Nov 15
8:15 AM - 9:30 AM

Tracks: Legal, Management & Compliance Issues, Management Path

Speaker(s): Brian Flood, JD, AHFI
Faculty will explore the most important emerging anti-fraud legal and regulatory developments including recent state and federal court decisions, f... More...

Community Mental Health Centers: A Case Study (Room Seaport B)

19 Nov 15
8:15 AM - 9:30 AM

Tracks: Behavioral Health Fraud Schemes

Speaker(s): Ritchard Houdashelt ; Shubhra Shivpuri ; Thomas Daly
Federal agents present a recent case study of one of the largest health care fraud schemes to date involving three Community Mental Health Centers ... More...

Conducting a Lab Audit from Chart to Bill (Room Seaport C)

19 Nov 15
8:15 AM - 9:30 AM

Tracks: AHFI Path, Fraud Schemes and Investigative Skills

Speaker(s): Melissa Scott, CHC, CPC
Expert faculty will demonstrate the steps of a laboratory audit, and focus on the red flags that can be identified throughout the process. The sess... More...

Dental Fraud Schemes in the Commercial & Public Sector (Room Balboa ABC)

19 Nov 15
8:15 AM - 9:30 AM

Tracks: Detecting and Investigating Dental Fraud

Speaker(s): Richard Celko, DMD, MBA, AHFI ; Stewart Balikov, DDS, AHFI
Dental fraud, waste and abuse schemes in both the commercial and public sectors appear with many similarities, however investigators need to be awa... More...

Endoscopic Sinus Surgery (Room Seaport F)

19 Nov 15
8:15 AM - 9:30 AM

Tracks: Clinical Issues for the Health Care Fraud Investigator

Speaker(s): Fred Holt, MD, JD, AHFI
The popularity of endoscopic sinus surgery has soared among Otolaryngologists since its introduction in the 1980s. Now balloon dilatation of the si... More...

Home Health Care (Room Seaport H)

19 Nov 15
8:15 AM - 9:30 AM

Tracks: Fraud Schemes and Investigative Skills, Law Enforcement Path

Speaker(s): Fernando C. Alvarez, JD
The presenters will discuss in detail the latest in current home health fraud schemes and program vulnerabilities. The discussion will include the ... More...

Oncology Services Fraud Case Study (Room Seaport D-E)

19 Nov 15
8:15 AM - 9:30 AM

Tracks: Fraud Schemes and Investigative Skills, Law Enforcement Path

Speaker(s): Abhijit Dixit ; Bryan Drake ; Catherine Dick
This presentation will detail a fast-paced health care fraud investigation into Dr. Farid Fata, an oncologist arrested in August 2013 on charges of... More...

Will Fraud, Waste, Abuse Exist in an ACO World? (Room Seaport A)

19 Nov 15
8:15 AM - 9:30 AM

Tracks: Anti-Fraud Technology Solution

Speaker(s): James B. Peake, MD ; Robert Haskey, MD
Join this presentation that will explore the world of Accountable Care Organizations, the concepts that have led to same, and the architecture of t... More...

Compounding Case Study (Room Seaport F)

19 Nov 15
10:15 AM - 11:15 AM

Tracks: Law Enforcement Path, Pharmacy & Part D Fraud

Speaker(s): Eric Rubenstein ; James Boazzo
This presentation will focus on the Medicare Part D pharmacy benefit with respect to compounding prescriptions. Faculty will explore the Part D pay... More...

Disability Fraud (Room Gaslamp A-C)

19 Nov 15
10:15 AM - 11:15 AM

Tracks: AHFI Path, Disability, Workers' Compensation & Supplemental Insurance Product

Speaker(s): Brent Walker, AHFI ; Mitchell Sherrod, AHFI
This presentation will approach disability fraud from the fraudster's perspective. From this view, attendees will walk through the thought proc... More...

Fraud Under the Affordable Care Act: Year Two (Room Seaport G)

19 Nov 15
10:15 AM - 11:15 AM

Tracks: Management Path, Transformation of Health Care

Speaker(s): Carolyn Ham, JD, AHFI
Individuals and small groups are now able to obtain health insurance with no pre-existing conditions and very limited underwriting through state he... More...

Prosecuting Reverse False Claims (Room Seaport H)

19 Nov 15
10:15 AM - 11:15 AM

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

Speaker(s): Christopher Haney, CPA, CFE ; Reuben Guttman ; Sam Sheldon, JD
Faculty will explain the current climate for prosecuting Reverse False Claims, identify investigative techniques for identifying and resolving pote... More...

Rise of Opiods: How Proactive Approaches to Analytics, Investigations and Partnerships Counter Fraud (Room Seaport B)

19 Nov 15
10:15 AM - 11:15 AM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Edward Hewitt, Sr., AHFI, CFE Sr. ; Erwin Acuna, CFE
The number of Medicare beneficiaries receiving commonly abused opioids rose by 92% between 2006 and 2014, compared with a 68% increase for all drug... More...

Stop Fraudsters in Their Tracks and Prevent Profit Leakage (Room Seaport A)

19 Nov 15
10:15 AM - 11:15 AM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Ed Rounds ; Robert McGinley
It is estimated that $3.5 trillion is lost each year to fraud and financial crimes. More and more, public and private enterprises are using sophist... More...

Testosterone Therapy (Room Seaport C)

19 Nov 15
10:15 AM - 11:15 AM

Tracks: Clinical Issues for the Health Care Fraud Investigator

Speaker(s): Gordon Grundy, MD ; Linda Cote, AHFI
The presenters will discuss in detail the clinical indications for testosterone therapy, and how the recent publicity regarding this treatment as a... More...

Why Excel Isn't the Solution for Payment Integrity (Room Balboa ABC)

19 Nov 15
10:15 AM - 11:15 AM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Rick Sluder, CFE
To prepare for today's data challenges and beyond, government-funded and commercial insurance plans need a data management infrastructure that ... More...

Building a Model to Combat Workers' Compensation Fraud (Room Gaslamp A-C)

19 Nov 15
11:30 AM - 12:30 PM

Tracks: Disability, Workers' Compensation & Supplemental Insurance Product, Law Enforcement Path

Speaker(s): Ingrid Petrakis, RN, BSN ; Tracey Ruppel
To prepare for today's data challenges and beyond, government-funded and commercial insurance plans need a data management infrastructure that ... More...

Compromised Clinics and their impact on Medicare Part A, B, and D Fraud (Room Seaport F)

19 Nov 15
11:30 AM - 12:30 PM

Tracks: Law Enforcement Path, Pharmacy & Part D Fraud

Speaker(s): Daniel Crespi ; Roger Cruz ; Stephen Mahmood
Faculty will describe a large scale fraud scheme involving multiple interrelated prosecuted cases which are linked to over $40 million dollars in P... More...

Effectively Integrating External Data into your Investigation (Room Balboa ABC)

19 Nov 15
11:30 AM - 12:30 PM

Tracks: Anti-Fraud Technology Solution

Speaker(s): Karen Weintraub, MA, AHFI, CPC-P, CPMA ; Kathleen Shaker, BSN, RN, AHFI, CPC, CPC-H ; Tony Rademeyer, MBA
Attendees will learn how to identify data resources and key industry websites to obtain information that will enhance their investigations. Many of... More...

Fraud Analytic Techniques: Simple Techniques to Uncover Complex Schemes (Room Seaport C)

19 Nov 15
11:30 AM - 12:30 PM

Tracks: AHFI Path, Fraud Schemes and Investigative Skills

Speaker(s): James McCall, AHFI
The presenter will first introduce a suspect behavior classification model that breaks fraud risk into four easy to understand groups, frequency, d... More...

Getting it Straight: Chiropractic and Physical Medicine Services (Room Seaport A)

19 Nov 15
11:30 AM - 12:30 PM

Tracks: AHFI Path, Clinical Issues for the Health Care Fraud Investigator

Speaker(s): Daniel Bowerman, DC, AHFI, CPC
Chiropractic anti-fraud expert provides a look at the chiropractic office visit and how to identify medically unlikely occurrences from the medical... More...

Mental Health Services and the ACA (Room Seaport B)

19 Nov 15
11:30 AM - 12:30 PM

Tracks: Behavioral Health Fraud Schemes

Speaker(s): Elizabeth Martin, JD ; James Slayton, MD
FWA detection and analysis has taken on new importance post ACA as health plans are now managing expanded public sector population behavioral healt... More...

Preparing for Medicare Audits (Room Seaport G)

19 Nov 15
11:30 AM - 12:30 PM

Tracks: Legal, Management & Compliance Issues, Management Path

Speaker(s): Virgilio Florentino
From mock run throughs to corrective action plan remedies, hear best practices when preparing for Medicare audits. Faculty will share examples of s... More...

Using Prescription Drug Monitoring Program Data to Identify Fraud (Room Seaport H)

19 Nov 15
11:30 AM - 12:30 PM

Tracks: Fraud in Medicaid Program, Law Enforcement Path

Speaker(s): Jaya Tripathi ; Judith Coffey ; Taya Fernandes
Making a prosecutable case against a pill-mill operator and its employees can be challenging. Because these cases always involve a practitioner who... More...

Ambulance Fraud (Room Seaport F)

19 Nov 15
2:00 PM - 3:15 PM

Tracks: Fraud Schemes and Investigative Skills, Law Enforcement Path

Speaker(s): Anderson Smith ; Christina Ramirez ; Jeremy Thornton
The ambulance industry, especially the area of ambulance transportation for dialysis patients, is extremely vulnerable to fraud and abuse. During t... More...

Clinical Laboratory Case Study (Room Seaport H)

19 Nov 15
2:00 PM - 3:15 PM

Tracks: Fraud Schemes and Investigative Skills, Law Enforcement Path

Speaker(s): John Croes ; Tom Floersch
The presenters will discuss schemes used to defraud Medicare and private insurances in the area of clinical laboratories and ways to investigate an... More...

Dental Directors' Quick Hits Panel (Room Balboa ABC)

19 Nov 15
2:00 PM - 3:15 PM

Tracks: Detecting and Investigating Dental Fraud

Speaker(s): George Koumaras, DDS, AHFI ; James A. Balukjian, DDS, AHFI, CDC, MBA ; Katina Spadoni, DDS, CDC, AHFI ; Stewart Balikov, DDS, AHFI
Dental Directors supporting NHCAA Member Organization SIUs will discuss dental claim they are currently seeing in their networks, and offer suggest... More...

Functional Medicine (Room Gaslamp A-C)

19 Nov 15
2:00 PM - 3:15 PM

Tracks: Management Path, Transformation of Health Care

Speaker(s): Jeffrey L. Scott, DO ; Melissa Scott, CHC, CPC
Faculty will examine the clinical foundation of functional medicine and why the concept of "biochemical individuality" can lead to risk for fraud, ... More...

Genetic and Biomarker Testing (Room Seaport C)

19 Nov 15
2:00 PM - 3:15 PM

Tracks: Clinical Issues for the Health Care Fraud Investigator

Speaker(s): Kristine Bordenave, MD, FACP ; Ksenia Coble, RN, CPC
Expert faculty will explain the current genetic and biomarker testing environment and its current sales appeal in the US. The presenters will descr... More...

Government Anti-Fraud Initiatives: Perspective from the Outside (Room Seaport A)

19 Nov 15
2:00 PM - 3:15 PM

Tracks: Management Path, Transformation of Health Care

Speaker(s): Peter P. Budetti, MD, JD
Dr. Budetti, former Deputy Administrator of the Centers for Medicare and Medicaid Services, will share his experience and insight on the state of g... More...

Hospice Storm Project: Identifying Hospice Fraud in the Medicaid Program (Room Seaport B)

19 Nov 15
2:00 PM - 3:15 PM

Tracks: Fraud in Medicaid Program, Law Enforcement Path

Speaker(s): Christopher Covington ; David Delgado
The presentation will focus on the epidemic of hospice fraud in Mississippi with an emphasis on the 'Hospice Storm' project which seeks to ... More...

Prosecuting Hospital Fraud: a Case Study (Room Seaport G)

19 Nov 15
2:00 PM - 3:15 PM

Tracks: Fraud Schemes and Investigative Skills, Law Enforcement Path

Speaker(s): Jack Geren, CFS ; Nathan Kummerfeld, JD
Through the experiences of a team that successfully prosecuted a hospital chain owner for his role in up-coding DRG payments across multiple hospit... More...

Emerging Fraud Schemes in Medicare (Room Seaport G)

19 Nov 15
3:30 PM - 5:00 PM

Tracks: Fraud Schemes and Investigative Skills, Law Enforcement Path

Speaker(s): Jennifer Trussell
This session will examine emergent schemes impacting the Medicare and Medicaid program, and tips on the rapid identification of these schemes. Frau... More...

Management Roundtable Discussion (Room Seaport A)

19 Nov 15
3:30 PM - 5:00 PM

Tracks: Legal, Management & Compliance Issues, Management Path

Speaker(s): Carmen E. Russo, AHFI, CFE ; Ralph J. Carpenter
A combination of networking and education, this high energy session features interactive roundtable discussion of SIU management topics faced by un... More...

Operation Cinco Castillos: New Physical Therapy and J Code Schemes Targeting Private Insurance Carriers (Room Seaport F)

19 Nov 15
3:30 PM - 5:00 PM

Tracks: Fraud Schemes and Investigative Skills, Law Enforcement Path

Speaker(s): Christopher J. Clark ; Harlen Johnston ; Kristin Bailey
This case study examines the investigation of a scheme to defraud privately insured health care plans, chiefly self-insured employers, who offered ... More...

Workers' Compensation: a Grant Funding Model to Bolster Anti-fraud Efforts (Room Seaport B)

19 Nov 15
3:30 PM - 5:00 PM

Tracks: Disability, Workers' Compensation & Supplemental Insurance Product

Speaker(s): Alan Kessler, JD ; Dominic Dugo
As a result of the serious problem of WC fraud, California has established grant funding of approximately $55 million a year for anti-fraud efforts... More...

Conference adjourns for the day

19 Nov 15
5:30 PM - 6:00 PM
Enjoy the evening! See you at 8:00 a.m. on Friday for the Breakfast General Session, Internet Profiling & Intelligence Gathering with Michele S... More...