2011 NHCAA Annual Training Conference Materials
Keynote Presentation
Jim Gee
Ethics for the Health Care Investigator
Kirk J. Nahra
Darrell Langlois
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WEDNESDAY 9:15 am – 10:30 am |
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| 9:15 am | Diagnostic Procedures & Clinical Modalities across Sub-Specialties
Location: Regency VI John S. Yao, MD, MPH, MBA, MPA, FACP |
| 9:15 am | Dental Treatment and Treatment Patterns Location: Regency VII Benjamin Andersen, AHFI Tim Custer, DDS Track: Identifying Dental Fraud |
| 9:15 am | Using Extrapolation in Investigations (R) | Handout
Location: Regency V Darrell Langlois, CPA, AHFI, CIA M. Suzanne Moody, PhD Chris Hunter Track: Investigator’s Toolbox |
| 9:15 am | CMS Program Integrity Update
Location: Centennial IV Peter P. Budetti, MD, JD Track: Legal, Management & Regulatory |
| 9:15 am | Life Insurance Fraud Location: Hanover AB Note: presentation will not be available online. Mik Kelly, CFE, LTCP Track: Life, Disability, Long-Term Care and Workers’ Compensation |
| 9:15 am | Impact your Bottom Line by Giving your Data a Voice
Location: The Learning Center Presented by EDIWatch, Inc., an NHCAA Premier Supporting Member David A. Botsko, PhD, CFE Arjomand Rahimzadeh, RN, BSN Track: Anti-Fraud Technology Solutions |
| 9:15 am | Anatomy of an SIU Compliance Audit: What to Expect When Your Program Is Audited for the First Time
Presented by ViPS, an NHCAA Premier Supporting Member Jala Attia, AHFI, CFE Karen Weintraub, MA, AHFI, CPC-P, CPMA Track: Anti-Fraud Technology Solutions |
| 9:15 am | Observation Units: A Growing Concern
Location: Centennial III Michael Cohen Louis Patalano, IV Track: Fraud Detection & Investigation in Specialty Areas |
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WEDNESDAY 11:15 am – 12:30 pm |
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| 11:15 am | Role of Medical Coverage Policy Development in Combating Fraud & Abuse
Location: Regency VI Daniel R. Barnett, MD Edwin Fischl, MD, MS, MBA, AHFI Gordon W. Grundy, MD, MBA Fred Holt, MD, JD, AHFI Edward N. Hunsinger, MD George M. Koumaras, DDS Track: Clinical Issues for the Health Care Fraud Investigator |
| 11:15 am | Physical and Rehabilitative Therapy Fraud
Location: Regency VII Note: presentation will not be available post-conferenceGreg Itsines Shimon Richmond Heather Tucci Track: Fraud Detection & Investigation in Specialty Areas |
| 11:15 am | Part D Fraud Schemes
Location: Centennial III Matthew Berls Kelly Giancristoforo, AHFI, CFE Track: Fraud Detection & Investigation in Specialty Areas |
| 11:15 am | Lessons from the UK
Location: Regency V Ray Collins Simon Peck, BS, DA, ACA Track: Investigator’s Toolbox |
| 11:15 am | Health Care Fraud Strike Force, 2011 and Beyond
Location: Centennial IV Note: presentation will not be available onlineHank Walther Track: Legal, Management & Regulatory |
| 11:15 am | Forensic Accounting in Disability Fraud Investigations
Location: The Learning CenterRobert D. Russo Track: Life, Disability, Long-Term Care and Workers’ Compensation |
| 11:15 am | The IBM Watson Fraud Analytics Jeopardy! Challenge
Location: Hanover CD Presented by IBM, an NHCAA Premier Supporting Member Shaun Barry Pete Bouchard Rob McGinley Track: Anti-Fraud Technology Solutions |
| 11:15 am | Using Predictive Analytics, Technology and the Human Touch to Fight Fraud
Location: Hanover AB Presented by Verisk Health, an NHCAA Premier Supporting Member Note: presentation will not be available online.Karthik Balakrishnan, Ph.D. Barry L. Johnson, DDS Track: Anti-Fraud Technology Solutions
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WEDNESDAY 2:30 pm – 3:45 pm |
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| 2:30 pm | Investigating Pediatric Fraud (R)
Location: Regency VI Gordon W. Grundy, MD, MBA Track: Clinical Issues for the Health Care Fraud Investigator |
| 2:30 pm | Dental Fraud Case Examples (R)
Location: Regency VII Kimberly A. Brown, RDH George Koumaras, DDS Joseph Parker, Jr. Patricia M. Shifflett, RDH Track: Identifying Dental Fraud |
| 2:30 pm | Identifying and Preventing Phantom Provider Schemes (R)
Location: Centennial III Thomas Corrigan, CFE Scott Drown Jane Grover Track: Fraud Detection & Investigation in Specialty Areas |
| 2:30 pm | Implementing or Expanding a Seizure Program
Location: Hanover AB Note: presentation will not be available onlineRobb Breeden Brandy Colfescu Doug Leff Track: Investigator’s Toolbox |
| 2:30 pm | Senior Medicare Fraud Patrol Panel (R)
Location: Centennial IVBarbara Dieker, MPA John G. Morris, Jr., AHFI, CFE Jean Stone Track: Legal, Management & Regulatory |
| 2:30 pm | Secrets of the System: A Wall Street Journal Series on Medicare
Location: Regency V Note: presentation will not be available online.Mark Schoofs Please read the following: In Medicare’s Data Trove, Clues to Curing Cost Crisis Published October 25, 2010, Wall Street Journal A Device to Kill Cancer, Lift Revenue Published December 10, 2010, Wall Street Journal Top Spine Surgeons Reap Royalties, Medicare Bounty Published December 20, 2010, Wall Street Journal Confidentiality Cloaks Medicare Abuse Published December 22, 2010, Wall Street Journal Track: Legal, Management & Regulatory
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| 2:30 pm | Social Network Analytics: Its Role in the Identification and Prevention of Health Care Fraud
Presented by LexisNexis, an NHCAA Premier Supporting Member Bill Fox, JD, MA Track: Anti-Fraud Technology Solutions |
| 2:30 pm | Entrepreneurs in Health Care Fraud
Location: The Learning Center Presented by OptumInsight, an NHCAA Premier Supporting Member Louise Dobbe Russ Littlefield Track: Anti-Fraud Technology Solutions |
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WEDNESDAY 4:00 pm – 5:00 pm |
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| 4:00 pm | 2011 Investigation of the Year
Location: Centennial III Note: presentation will not be available online Welcome the winners of NHCAA’s 2011 Investigation of the Year Award and learn from the investigative strategies, multi-organization cooperation and case-building excellence that led to a successful resolution as well as to the coveted NHCAA honor. Track: Fraud Detection & Investigation in Specialty Areas |
| 4:00 pm | Trends in Medical Identity Theft
Location: Regency VII Andrew McKee Track: Fraud Detection & Investigation in Specialty Areas |
| 4:00 pm | Staying Ahead of the Curve: State Regulatory Update
Location: Hanover CD Ted Clark Leigh McKenna Track: Legal, Management & Regulatory |
| 4:00 pm | End of Life Care | Handouts
Location: Regency VI Frank J. Dubeck, Jr., MD Track: Clinical Issues for the Health Care Fraud Investigator |
| 4:00 pm | Investigating Dental Fraud
Location: Regency V Jamie S. Johnston, AHFI, CFE, CPC, HCAFA, DBA Phyllis Heller, AHFI Track: Identifying Dental Fraud |
| 4:00 pm | Complex Coding Skill: Oncology Infusion Coding
Location: Centennial IV Cindy C. Parman, CPC, CPC-H, RCC Track: Investigator’s Toolbox |
| 4:00 pm | Partnering for Effective Disability & Health Care Fraud Task Forces
Dominic Dugo Track: Life, Disability, Long-Term Care & Workers’ Compensation |
| 4:00 pm | A Game Changing Approach to Stopping FWA – How a Payer is Achieving Real Results
Location: Hanover AB Presented by FICO, an NHCAA Premier Supporting Member Andrea Allmon, PhD Dennis Latsha Marilee Willey, RN, CPC, CPC-H, RAC-CT Track: Anti-Fraud Technology Solutions |
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THURSDAY 7:00 am – 8:30 am |
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| 7:00 am | Taking the Right Steps to Secure Member Data
Location: Hanover C Presented by ACS, an NHCAA Premier Supporting Member RG Conlee Sara Fitzsimmons Track: Anti-Fraud Technology Solutions |
| 7:00 am | Making Every Dollar Count: Tools and Technology to Optimize the SIU – A Panel Discussion
Presented by Emdeon, an NHCAA Premier Supporting Member Thomas P. Brennan, Jr., AHFI John Shoemaker, MBA, CFE, CPA Kyle Cheek, Ph.D. Mark Isbitts Track: Anti-Fraud Technology Solutions |
| 7:00 am | The Key to Unlocking Skilled Nursing Facility Fraud, Waste, and Abuse
Location: Hanover FG Presented by IntegriGuard, An NHCAA Premier Supporting Member Ira Nathan, ASA, MAAA Christina Stillwell-Deaner, MPH, CPH, RN Jean Tonje, MBA Track: Anti-Fraud Technology Solutions |
| 7:00 am | Real World Examples of Decreasing Waste and Abuse Through Pre-pay Prevention
Location: Hanover DE Presented by McKesson, an NHCAA Premier Supporting Member Catherine Pavlov, RN Diane Ward, RN, MHSA, CCS-P, AHFI Track: Anti-Fraud Technology Solutions |
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THURSDAY 8:45 am – 10:00 am |
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| 8:45 am | Identifying FWA in Behavioral Health (R)
Location: Centennial II Margaret Brennecke, Ph.D. Jim Slayton, MD Track: Clinical Issues for the Health Care Fraud Investigator |
| 8:45 am | Dental Fraud: The Claim Review Perspective |
| 8:45 am | New Approach to Failure of Care Cases
Location: Centennial IV Cathy Pascale, Esq. Andrew S. Penn Track: Fraud Detection & Investigation in Specialty Areas |
| 8:45 am | Structured Criminal Activity Trends in Health Care Fraud
Location: Centennial III Note: presentation will not be available online Jennifer Trussell Track: Fraud Detection & Investigation in Specialty Areas |
| 8:45 am | Looking into a Transatlantic Mirror: EU vs US
Implementing the 7 NHCAA Guiding Principles for Combating Health Care Fraud in Europe: How high does Europe score? Location: Dunwoody Paul Vincke Track: Legal, Management & Regulatory |
| 8:45 am | MEDIC/Health Plan Cooperation (R)
Location: Regency VII Martina Gilly Presley Rebman, AHFI, CFE, PMP Danielle Van De Hey, HCAFA Track: Legal, Management & Regulatory |
| 8:45 am | The Bad Apples of Behavioral Health
Location: Regency V Presented by HMS, an NHCAA Premier Supporting Member Jill S. Costen Christie Watson, CPA, CFE Track: Anti-Fraud Technology Solutions |
| 8:45 am | Advanced Analytics in Fighting Health Care Fraud – a Public and Private Perspective
Location: Regency VI Presented by SAS, an NHCAA Premier Supporting Member Ted Doyle, MA, AHFI Gary H. Fuquay Julie Malida, FSA, MAAA Track: Anti-Fraud Technology Solutions |
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THURSDAY 11:00 am – 12:15 pm |
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| 11:00 am | Diagnostic Radiology Services
Melody Mulaik, MSHS, CPC, CPC-H, RCC, PSC, FCS Track: Fraud Detection & Investigation in Specialty Areas |
| 11:00 am | Implementing Undercover Operations (R)
Location: Centennial III Dan Bowerman, DC, FACO, AHFI, CPC Howard Levinson, DC, AHFI, CFE, CPC Track: Fraud Detection & Investigation in Specialty Areas |
| 11:00 am | Electronic Medical Records (R)
Location: Centennial II James Taylor, MD, CPC Track: Investigator’s Toolbox |
| 11:00 am | Complex Coding Skill: Cardiology
Location: Regency VII Karna Morrow, CPC, RCC Track: Investigator’s Toolbox |
| 11:00 am | Disability Red Flags
Location: The Learning Center Note: presentation will not be available online post conference. L. David Covino, CFE, ALHC Track: Life, Disability, Long-Term Care and Workers’ Compensation
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| 11:00 am | Using Extrapolation in Investigations | Handout
Location: Regency V Darrell Langlois, CPA, AHFI, CIA M. Suzanne Moody, PhD Chris Hunter Track: Investigator’s Toolbox |
| 11:00 am | Senior Medicare Fraud Patrol Panel
Location: Centennial IVBarbara Dieker, MPA John G. Morris, Jr., AHFI, CFE Jean Stone Track: Legal, Management & Regulatory |
| 11:00 am | Solving Unique Anti-Fraud Concerns through Technology & Expertise
Location: Regency V Presented by TC³, an NHCAA Premier Supporting Member Moderator: Roberta Patrow Mac McIntyre Dennis Norton Rose Marie Tetzlaff Track: Anti-Fraud Technology Solutions |
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THURSDAY 2:00 pm – 3:15 pm |
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| 2:00 pm | Community Mental Health Centers
Location: Centennial II Note: presentation will not be available online. Ben Singer Jennifer L. Saulino Track: Fraud Detection & Investigation in Specialty Areas
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| 2:00 pm | Specialty Pharmaceuticals: Fraud, Waste & Abuse (R)
Location: Centennial III Alanna M. Lavelle, AHFI, MS, CPC Rodger Smith, JD Track: Fraud Detection & Investigation in Specialty Areas |
| 2:00 pm | Addressing Cultural Dynamics in Your Interviews
Location: Regency VII Note: presentation will not be available online Kirk A. Kennedy, Ph.D. Track: Investigator’s Toolbox |
| 2:00 pm | Top 10 Health Care Fraud Challenges for SIUs
Location: Centennial IV Kirk Nahra, Esq. Track: Legal, Management & Regulatory |
| 2:00 pm | Investigative and Legal Perspective on Provider and Workers’ Compensation Fraud Investigations
Location: The Learning Center Anthony DiPaolo, BS, MS, CFE Scott S. Faragi, CFE Lisa Gallagher, RN, BSN, JD, CFE Track: Life, Disability, Long-Term Care and Workers’ Compensation |
| 2:00 pm | ICD-10: A Perspective on Change
Location: Regency VI Presented by CGI, an NHCAA Premier Supporting Member Robert Haskey, MD Brian Lane, AHFI, CFE, MAJ Track: Anti-Fraud Technology Solutions |
| 2:00 pm | Best Practices in Detecting and Eliminating Waste and Fraud
Location: Regency V Presented by Thomson Reuters, an NHCAA Premier Supporting Member Raymond J. Fabius, MD, CPE, FACPE Mark Gillespie Jean MacQuarrie David Nelson Track: Anti-Fraud Technology Solutions |
| 2:00 pm | Investigating Pediatric Fraud
Location: Centennial I Gordon W. Grundy, MD, MBA Track: Clinical Issues for the Health Care Fraud Investigator |
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THURSDAY 3:30 pm – 4:45 pm |
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| 3:30 pm | Complex Case Challenge: Organizing the Evidence
Location: Centennial IV Note: presentation will not be available online. Marguerite Hackney Judy Sly Track: Investigator’s Toolbox
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| 3:30 pm | Long-Term Care Insurance
Location: The Learning Center Barbara A. Stencil, AHFI Track: Life, Disability & Investigation in Specialty Areas |
| 3:30 pm | Identifying FWA in Behavioral Health
Location: Centennial I Margaret Brennecke, Ph.D. Jim Slayton, MD Track: Clinical Issues for the Health Care Fraud Investigator |
| 3:30 pm | Leveraging Multi-Dimensional Analyses to Identify Fraudulent Encounters
Location: Regency VII Presented by MedAssurant, Inc., an NHCAA Premier Supporting Member Willis Gee Track: Anti-Fraud Technology Solutions |
| 3:30 pm | Identifying and Preventing Phantom Provider Schemes
Location: Centennial III Thomas Corrigan, CFE Scott Drown Jane Grover Track: Fraud Detection & Investigation in Specialty Areas |
| 3:30 pm | Dental Fraud Case Examples
Location: Centennial II Kimberly A. Brown, RDH George Koumaras, DDS Joseph Parker, Jr. Patricia M. Shifflett, RDH Track: Identifying Dental Fraud |
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FRIDAY 8:00 am – 9:30 am |
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| 8:00 am | The Treatment Trap: Overutilization of Medical Care Location: Regency VI Rosemary Gibson |
| 8:00 am | Off-Label Pharmaceutical Use: Botox
Michael Badolato, MHA, MBA Scott Stephan, BSN |
| 8:00 am | SIU Management Panel Discussion
Location: Regency V Ralph J. Carpenter Christopher J. Ferrara, AHFI Sharon Green, AHFI, CFE Carmen E. Russo, AHFI, CFE |
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FRIDAY 9:45 am – 11:00 am |
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| 9:45 am | MEDIC/Health Plan Cooperation
Location: Centennial IV Martina Gilly Track: Legal, Management & Regulatory |
| 9:45 am | Implementing Undercover Operations
Location: Centennial I Dan Bowerman, DC, FACO, AHFI, CPC Howard Levinson, DC, AHFI, CFE, CPC Track: Fraud Detection & Investigation in Specialty Areas |
| 9:45 am | Electronic Medical Records
Location: Centennial III James Taylor, MD, CPC Track: Investigator’s Toolbox |
| 9:45 am | Specialty Pharmaceuticals: Fraud, Waste & Abuse
Location: Centennial II Alanna M. Lavelle, AHFI, MS, CPC Rodger Smith, JD Track: Fraud Detection & Investigation in Specialty Areas |