2015 Annual Training Conference & Anti-Fraud Expo

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Sessions (97)

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...

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...

Internet Profiling and Intelligence Gathering (Room Seaport DE)

20 Nov 15
8:00 AM - 9:30 AM
Speaker(s): Michele Stuart
More...

Ethics for the Health Care Investigator (Room Seaport AB)

20 Nov 15
9:40 AM - 11:40 AM
Speaker(s): Darrell Langlois, CPA, CIA ; Nick Messuri
Two premier health care anti-fraud compliance instructors lead a 2-hour seminar on professional and investigative ethics for the health care fraud ... More...

Electrodiagnostic Medicine (Room Seaport F)

20 Nov 15
9:45 AM - 11:00 AM

Tracks: Clinical Issues for the Health Care Fraud Investigator

Speaker(s): Peter Grant, MD, PC
Faculty will provide an overview of EDX fraud and abuse in the US and then discuss the common types of EDX fraud and abuse including mobile diagnos... More...

Group Therapy (Room Seaport G)

20 Nov 15
9:45 AM - 11:00 AM

Tracks: AHFI Path, Behavioral Health Fraud Schemes

Speaker(s): Gary Henschen, MD
Faculty examines the group therapy visit, with a focus on the behavioral health benefit, correct coding and best clinical practices. Common schemes... More...

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

20 Nov 15
9:45 AM - 11:00 AM

Tracks: Fraud Schemes and Investigative Skills, Law Enforcement Path

Speaker(s): Christopher Covington ; David Delgado
Faculty examines the group therapy visit, with a focus on the behavioral health benefit, correct coding and best clinical practices. Common schemes... More...

Oncology Services Fraud Case Study (Room Seaport C)

20 Nov 15
9:45 AM - 11:00 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...

Conference Adjourns

20 Nov 15
11:30 AM - 12:00 PM
Save the Date! 2016 Annual Training Conference  November 15-18, 2016 Hyatt Regency Atlanta Atlanta, Georgia More...