Combating Healthcare Fraud & Abuse

Venue: Harrah\'s Las Vegas

Location: Las Vegas, Nevada, United States

Event Date/Time: Jan 28, 2004 End Date/Time: Jan 30, 2004
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Prevention and Detection Technologies for Health Plans

With the annual total cost of healthcare fraud approaching $100 billion - costing the average American household an extra $200 per year in additional premiums, it is clear that the initial efforts to reduce healthcare fraud and abuse are not enough. Given that not every case of fraud uncovered will be prosecuted and many more cases are never even detected, health insurers agree that employing technologies for the prevention and detection of healthcare fraud is the best possible defense. The Institute for International Research is pleased to present these and other strategies for overcoming healthcare fraud during the Combating Healthcare Fraud and Abuse, Prevention and Detection Technologies for Health Plans conference. This event is designed to provide a forum for healthcare payers to share valuable tools and strategies that aid in the investigation, monitoring/tracking and litigation of healthcare fraud in addition to effective technologies used in preventing and detecting fraud committed against health insurers and their members.

On Wednesday, January 28, 2004 the event opens with a half-day workshop focusing on strategies for Special Investigation Units to Maximize Efficiencies and the Best Practices for Managing Special Investigation Units.

The main conference opens on Thursday, January 29, 2004 with a kick-off presentation from Louis Parisi, President of AIG World Investigative Resources, Inc. Mr. Parisi provides a brief overview of the evolution of healthcare fraud and anti-fraud initiatives from his years of experience with the New Jersey Department of Insurance, as Vice President of Empire Blue Cross Blue Shield and now with AIG, Inc in New York. Following the brief overview Mr. Parisi shares specific tips and techniques for successful fraud investigation and recovery. Next, Virginia's Anthem Blue Cross Blue Shield presents a case study on the technology they developed internally for successful case management and data analysis. Then ViPS's Director of Anti-fraud Products and Services co-presents on powerful technologies and helpful techniques for building fraud cases. The next session presented by the US Postal Inspection Service, St. Louis division, discusses how health plans can use existing information from their own files for successful insurance fraud prosecutions. Speakers and attendees then come together for a round table discussion to share their own techniques resulting in successes and disappointments in overcoming healthcare fraud and abuse. The next technology case study co-presented by CGI highlights data mining technologies and retrospective systems for detection. Rebecca Busch of Medical Business Associates follows with guidance on how to leverage emerging technologies and PHI audits to fight fraud and abuse. The J. Bolen Group's President next discusses prescription drug abuse and drug diversion, followed by a discussion on medical mills, and ancillary fraud schemes presented by Regence Blue Shield of Idaho.

On Friday, January 30th the day begins with a technology case study co-presented by PCG Software on multiple technology strategies for stopping healthcare fraud. Blue Shield of California then provides us with information on foreign claim fraud and how to expose it. Janet Newberg, former Chief Prosecutor for the US Attorney's Office in the District of Minnesota reveals what health plans need to know for successful fraud actions. Next, Mary Louise Cohen, Partner with Phillips and Cohen Law provides a step by step look at how a qui tam case develops. PricewaterhouseCoopers then presents strategies that detect fraud committed by health plan employees and the conference closes with a round table discussion on how fraud schemes using EMR's are being conducted and how they can be stopped.