Healthcare Fraud Driving Organized Crime: Examining Sources of Illicit Income
This session will familiarize investigators with the connection between healthcare fraud schemes and financial crimes, and fraud’s increasing importance in organized crime. This webinar will examine case study examples and provide effective techniques for detecting, preventing and responding to healthcare fraud, as well as practical advice for leveraging law enforcement partnerships in support of identification and recovery of misappropriated assets.
Recorded
Jul 26 2017
56 mins
Your place is confirmed,
we'll send you email reminders
we'll send you email reminders
Presented by
Erin Picton, AHFI, Investigations Manager, and Mark Starinsky, Service Delivery Manager, General Dynamics Health Solutions
Erin Picton, AHFI, Investigations Manager, and Mark Starinsky, Service Delivery Manager, General Dynamics Health Solutions
Presentation preview:
Network with like-minded attendees
-
![[[ session.user.profile.displayName ]]](data:image/gif;base64,R0lGODlhAQABAIAAAP7//wAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==)
- [[ session.user.profile.displayName ]]
- [[ session.user.profile.jobTitle ]]
- [[ session.user.profile.companyName ]]
- [[ userProfileTemplateHelper.getLocation(session.user.profile) ]]
-
- [[ card.displayName ]]
- [[ card.jobTitle ]]
- [[ card.companyName ]]
- [[ userProfileTemplateHelper.getLocation(card) ]]
- Channel
- Channel profile
-
Detecting Fraud, Waste and Abuse in Laboratory Testing Recorded: Sep 20 2017 57 mins
Gerry Petrowski and Suzanne Baker, General Dynamics Health SolutionsUrine drug screening and genetic testing are ongoing areas of concern for fraud, waste and abuse (FWA) investigators. This session will familiarize investigators with common schemes found in laboratory claims data and provide effective methods for detecting, preventing and responding to healthcare fraud. Additionally, this webinar will examine documentation requirements to support payments for drug screenings, as well as review the key components necessary to conduct a thorough medical review and to write a clear, concise audit findings report. -
Healthcare Fraud Driving Organized Crime: Examining Sources of Illicit Income Recorded: Jul 26 2017 56 mins
Erin Picton, AHFI, Investigations Manager, and Mark Starinsky, Service Delivery Manager, General Dynamics Health SolutionsThis session will familiarize investigators with the connection between healthcare fraud schemes and financial crimes, and fraud’s increasing importance in organized crime. This webinar will examine case study examples and provide effective techniques for detecting, preventing and responding to healthcare fraud, as well as practical advice for leveraging law enforcement partnerships in support of identification and recovery of misappropriated assets. -
Dermatological Coding Complexities and Opportunities for Fraud, Waste and Abuse Recorded: Jun 29 2017 53 mins
Lindsay Surynt, Investigator, and Katherine Bass, Investigator, General Dynamics Health SolutionsDermatology is a complex clinical specialty comprising hundreds of procedure codes for surgical services related to lesion removals, biopsies and excisions. This session will familiarize investigators with dermatology’s complex clinical coding issues by reviewing accurate reporting requirements and specific sections of the National Correct Coding Initiative, or NCCI. Our experts will also demonstrate applicable data mining techniques. -
Opioid Abuse: Scripting the Way to Addiction Recorded: May 24 2017 58 mins
John Maguire, M.D., Chief Medical Officer and Mark Starinsky, AHFI, CFE, CHC, Service Delivery Manager, GD HealthWith dramatic increases in prescription opioid availability, usage and spending, this session will explore popular fraud schemes associated with drug abuse and discuss effective data mining to identify such behavior. This session will help investigators combat the opioid epidemic through discussion of contributing factors of opioid availability, common fraud schemes used by drug seekers and Federal and State intervention strategies aimed at reducing prescription opioid abuse. -
Demystifying Statistical Sampling for the Fraud Investigator Recorded: Mar 30 2017 68 mins
Mark Starinsky, Service Delivery Manager, General Dynamics Health SolutionsWith attributes, variables and clusters, even the vocabulary of statistical sampling can be challenging to the lay investigator. However, proper understanding and command of these terms is essential to mastering the tools and techniques necessary for preparing statistically-valid random samples. This skills-based webinar will review important sampling terminology, the benefits and applications of sampling to healthcare audits and investigations, and include demonstration of preparing a sampling data set with OIG’s commonly-used RAT-STATS. -
Using Post-payment Insights to Build Strong Pre-payment Claims Review Programs Recorded: Dec 14 2016 51 mins
Erin Picton, AHFI, Investigations Manager, General Dynamics Health SolutionsBuilding and maintaining an effective pre-payment claims review program can be challenging without leveraging prior inappropriate billing patterns or checks against fraud trends that were previously identified during post-payment claims reviews. In this session, participants will learn the importance of gathering and leveraging information from post-payment reviews to significantly strengthen pre-payment review programs, as well as the use of ICD-10 codes and outliers that can help generate new leads based on current billing trends and better address claims system vulnerabilities. -
General Dynamics IT: 5-Step Process to Secure Cloud Migration Recorded: Nov 17 2016 30 mins
Srinivas Singaraju, Chief Architect, Cloud Solutions, General Dynamics ITCloud computing shares distributed resources at various levels (SaaS/PaaS/IaaS), and can present challenges in operating a secure environment, forcing CIO’s and agency heads to address questions about cloud migration, such as: What will be the impact on my agency’s legacy applications? What challenges do I need to overcome to be successful? What strategies will help my agency overcome those challenges? Learn how to migrate to the cloud through a 5-step process that embeds security at every stage, ensuring a successful cloud migration. -
Preparing Effective Reports: Have You Got the “Write” Information? Recorded: Nov 10 2016 60 mins
Mark Starinsky, AHFI, CFE, Program Manager, General Dynamics Health SolutionsAs budgets decline and workloads increase, managers need information presented in a clear, concise way to make decisions. -
Maximizing Medical Records Retrieval to Improve Reported Rates Recorded: Oct 13 2016 40 mins
James Ullom, MRR Services Manager, General Dynamics Health SolutionsRetrieving medical records from providers can be the most challenging aspect of the HEDIS hybrid measure season and its success can have the most direct impact on hybrid rates. Learn ways to improve your chart retrieval processes to increase your success at receiving your member’s medical records during the busy HEDIS season. -
Coding in Obstetrics: Identifying Improper Payments Within OB/GYN Claims Data Recorded: Aug 10 2016 51 mins
Melissa Dupre, RN, CMSRN, CPC, Program Manager, Lindsay Surynt, Investigator, and Kaytlin Ceron, Investigator, GD HealthIn this session, participants will gain a better understanding of documentation and coding requirements for OB/GYN services in order to identify potential areas of fraud, waste and abuse. -
Pharmacy Fraud Schemes: Current Trends and Case Study Recorded: Jul 20 2016 58 mins
Melissa Dupre, RN, CMSRN, CPC, Program Manager and Todd Hains, CPhT, Senior Investigator, General Dynamics Health SolutionsParticipants will gain an understanding of current and trending schemes in pharmacy fraud such as compounding, inappropriate provision of non-approved FDA products, and prescription discount programs. -
Cloud Solutions and Services – AWS Partnership and Integration Experience Recorded: Jun 8 2016 7 mins
Ken Georgi, Vice President, Healthcare Enterprise Systems, General Dynamics Health SolutionsBased on our extensive integration experience and deep partnerships with a broad array of cloud service providers, General Dynamics Health Solutions supports customers in identifying the right solution to meet technical requirements, business functionality and budget. Whether you are moving to the cloud, already in the cloud or managing multiple clouds, we can guide your organization to the optimal solution for your unique mission and budget. -
General Dynamics Health Solutions Overview Recorded: Jun 6 2016 3 mins
General Dynamics Health SolutionsToday’s challenging healthcare environment demands that we find new ways to improve the quality of care, ensure efficiency and transform healthcare services. Learn how General Dynamics Health Solutions helps organizations successfully navigate this changing landscape and thrive in a new world committed to measuring outcomes and value. -
Cloud Solutions and Services – Overview Recorded: May 18 2016 2 mins
General Dynamics Health SolutionsWhether you are moving to the cloud, already in the cloud or managing multiple clouds, General Dynamics Health Solutions can guide your organization to the optimal solution for your unique mission and budget. Offering a portfolio of cloud solutions, we provide the choice and confidence to select the most cost-effective, functional and low-risk environment to meet business needs and requirements. -
Easing the Search for the Needle in the Haystack Using Data’s Red Flags Recorded: Apr 5 2016 62 mins
Jessica Gay and Mark Starinsky, Service Delivery Managers, General Dynamics Health SolutionsIn the absence of fraudulent providers’ confessions, data analysis is the backbone of successful FWA investigations. This session explores effective techniques for spotting red flags, using associated data analysis techniques, and detecting FWA across various provider specialties from different angles, including pooled data and public records. -
Using Predictive Analytics to Identify Risks and Reduce Costs Recorded: Feb 25 2016 42 mins
Liz Snavely, Director of Operations, General Dynamics Health Solutions and David Pierce, Director of Operations, MillimanLearn how using actionable data can optimize healthcare management. -
Arkansas’ Successful Payment Reform Recorded: Oct 12 2015 6 mins
Dr. William Golden, Arkansas Medicaid Medical DirectorArkansas Medicaid Medical Director, Dr. William Golden, addresses Arkansas’ successful Health Care Payment Improvement Initiative. -
Capabilities Overview Recorded: Oct 12 2015 2 mins
General Dynamics Health SolutionsDiscover our end-to-end health solutions helping organizations expand insight, ensure value and improve outcomes.
Expanding Insight. Ensuring Value. Improving Outcomes.
General Dynamics Health Solutions, part of General Dynamics Information Technology, provides end-to-end solutions and professional services to health organizations in the defense, federal civilian government, state and local government, commercial and international sectors. Headquartered in Fairfax, Va., with major offices worldwide, company capabilities include Health Data Management and Analytics, Multi-Channel Health Communications, Health Facility Outfitting and Logistics, Clinical Staffing and Medical Research Services, Healthcare Administrative Services, and IT Services and Infrastructure.
![[[ webcast.title ]]](/resources/images/diamond-100x75.jpg?v=052c2adf76a90d4d1843fdb32e04d1d3af8f6714)
Successfully added emails: 0
Remove all
- Title: Healthcare Fraud Driving Organized Crime: Examining Sources of Illicit Income
- Live at: Jul 26 2017 6:00 pm
- Presented by: Erin Picton, AHFI, Investigations Manager, and Mark Starinsky, Service Delivery Manager, General Dynamics Health Solutions
- From: