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Wednesday, December 9 • 1:30pm - 2:30pm
Track 4: Best Practices in Detecting Fraud

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Description – No program is immune to health care fraud. This session will offer best practices for identifying and addressing fraud through data analysis and medical reviews. See how Medicaid programs can benefit from Medicare fraud prevention.

Background
Noridian, as a Medicare Administrative Contractor and Unified Program Integrity Contract (UPIC) Indefinite Delivery Indefinite Quantity (IDIQ) and Supplemental Medical Review Contractor (SMRC), assesses and reports on fraud schemes. Noridian evaluates end-to-end information and performs reviews, in addition to developing study topics valuable to other payors.

Agenda
Discover how fraud topics are identified, developed and submitted to CMS and get ideas for your own best practices. Learn how we design and perform fraud-detecting analysis including:
  • Using data analysis to design a study
  • Building multiple perspectives into results
  • Supporting idea exploration and refinement
  • Setting a baseline
  • Reporting on results
You’ll leave with new tools to support your program’s integrity.


Speakers
avatar for Katie Shequen

Katie Shequen

Director of Medical Review, Noridian Healthcare Solutions
avatar for Bev Rohtert

Bev Rohtert

Special Projects Manager, Noridian Healthcare Solutions
Bev Rohtert is a Special Projects Manager at Noridian, a Certified Fraud Examiner and licensed Tennessee Private Investigator. She has over 25 years of program management, healthcare investigation, data analysis, medical review, compliance and auditing experience across private and... Read More →


Wednesday December 9, 2020 1:30pm - 2:30pm PST
TBA