2015 Annual Training Conference & Anti-Fraud Expo

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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, Senior Investigator, Aetna Inc.; Janine Kumanchik, AHFI, HCAFA, Manager, SIU, CareSource Management Group; Tina Sinclair, CPC, AHFI, Senior Investigator, Anthem, Inc.

Investigating Medicaid fraud can be infinitely more complex due to more stringent regulations, rules differing vastly between states, and a population that lends itself to schemes different from commercial and Medicare. Faculty will discuss, from experience, the unique challenges investigating fraud in the Medicaid populations they serve. Schemes will be discussed in terms of specific codes, data mining tips, and investigative examples to promote best practices when investigating fraud in the Medicaid program.

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