Call for Presentations

The NHCAA Institute for Health Care Fraud Prevention is now accepting abstracts for the 2020 Annual Training Conference, November 17-20, 2020 at the Hyatt Regency in New Orleans, Louisiana.

The Call for Presentations for the Annual Training Conference (ATC) will close on Thursday, April 30. Presentation submissions will be reviewed and evaluated by the ATC Committee for inclusion in the program. Accepted submissions will be announced in May.

What’s important this year?

  • Session levels
    The ATC continues to appeal to professionals with over 5 years’ experience in the health insurance industry. As a result, we are only looking for submissions where the content is directed at intermediate and experienced level professionals.
    • Intermediate - designed for individuals between 6-10 years
    • Experienced - designed for individuals with over 10 years’ experience
  • Data Analytics
    The ATC Committee is once again requesting that all submissions include a description of how data is used in the investigation, what codes were identified, and what can be replicated in other investigations.

    When submitting the abstract, provide the following information:

    • What data techniques were used to find the scheme?
    • How do you use analytics to drive an investigation?
    • Who is the audience for the session - the investigator vs. analyst?
    • What are the codes identified in this scheme (CPT, ICD-10, HCPCS, REV codes)?
  • Session Take-Aways
    Critical to the success of the ATC, is the emphasis on ensuring that attendees take away information, skills, and tools. Presenters will be required to include a closing slide that identifies three (3) things that the audience can use back in the office on their own investigations.
  • Track and Content Categories
    The ATC Committee has identified schemes and fraud topics that we would like to see included in this year’s program. We encourage you to submit presentations that address one of these areas.

The ATC Committee is seeking presentation abstracts in categories. Each category includes a list of topics identified as key issues for this year’s ATC program. This list is not comprehensive and other topics will be accepted. If you don’t see your topic, submit in our ‘Other’ category and include a statement explaining why the topic is relevant and should be shared with others.

Please review these broad categories before submission.

Expanding Your Investigative Skills 

Submissions should focus on how to build the investigative skills of the staff in the SIU units. The proposals should include detail on how to build skill sets for staff and team.

  • Investigation life cycle
    • Walk through the steps from receipt of an allegation to interviewing, report writing, and making a recommendation on the investigative outcome and referrals.
      • How did you find the scheme?
      • How did you run the data to determine if it validates or contradicts the current theory?
      • Who did you interview and who were your partners?
      • How did you transfer the case from carrier to law enforcement?
    • For complex schemes, how do you collaborate with other internal departments (e.g., IT, compliance, web team) or external partners? 
    • Best practices in referral development to law enforcement
      • How to prepare an actionable referral with a seamless hand off?
  • Data Analytics
    • How front-end data analysis led to results?
    • Best practices in data visualization and presentations
    • Predictive modeling techniques and how it is applied to fraud prevention
    • How do you present data and speak about data in a meaningful way?
  • Technology 
    • How do you use social media and IP addresses in an investigation?
    • How do you find evidence in the cloud?
    • How do you collaborate with other departments in your organization to work data in an investigation?
    • What is the future of technology in investigations?
    • How are you leveraging AI (aka machine learning)?
  • Clinical Auditing
    • Who do you look for?
    • What to look for when reviewing records for the SIU?
    • What info do you need to make determinations?
  • Medical record review
    • How do you review records?
    • What do you request when conducting an investigation?
    • What documentation support is needed?
    • How do you interpret?
  • Interviewing skills
    • What are best practices in interviewing? In person vs telephone?
  • When conducting an investigation, what should you look for when investigating any of the following schemes?
    • DME
    • Sober homes/ behavioral
    • ABA
    • Home health
    • Telefraud (a.k.a., telemedicine, telehealth)  

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Case Studies to Address Trending Schemes in Health Care Fraud

Our law enforcement agent and investigator audience will be interested in hearing case studies from their federal and state colleagues, along with health insurers. Case study submissions should clearly outline the role of data in the case, identify the steps in the investigation from beginning to end, outline how data was used to make the case, and explain how you worked with and communicated with the private/ public partners.

  • EFT and payment diversion schemes
  • Dark webs impact on health care – tracking IP addresses
  • Par/ non-par providers
  • Cyber crime in health care
  • Telefraud – a.k.a., Telehealth, telemarketing, telemedicine (dental/ medical)
  • Fraud in new payment models such as value-based payments, ACOs, etc
  • DME (e.g., orthodontics, breast pumps, wheelchairs)
  • Facilities fraud
  • Transportation
  • Kickbacks
  • 3rd party billers
  • Group eligibility
  • Experimental billing ‘covered’ (e.g., genetic testing)
  • Sober homes/ residential
  • Medical ID theft
  • Lab Testing (e.g., genetic testing, UDT, allergy testing, cardiac testing)
  • Medicare Part C

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Legal and Compliance Issues

Session proposals within this category can be both higher level legal issues for experienced attorneys, but also the application of complicated concepts to what investigators need to understand to effectively work a case. 

  • ERISA and Qui Tam issues
  • The do’s and don’ts of an investigation
    • What are the legal and regulatory concepts in an investigation
    • What is considered discoverable in an investigation?
    • What should investigators know about the legal issues in an investigation?
    • What evidence will prosecutors need in the case?
  • Stark law 
    • How do you find the relationships?
    • Where, when and where does it stop?
  • What are important health care statutes that investigators need to understand and how do they apply to an investigation?
  • Building Compliance Programs
    • What are the essential elements of a compliance program?
    • How do you manage reporting requirements? What are lessons learned that can be shared with other organizations? 
  • Preparing for audits
    • What are best practices in audit preparation? 
    • What should be expected with the new audit protocols?
    • What are best practices in partnering with the compliance area to prepare for a CMS audit?
  • Building a risk program, developing risk assessments
  • How criminal statutes relate to schemes (e.g., EKRA as it relates to sober homes) 

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Leadership and Management Issues

Leadership and management submissions should be designed to improve the skills set of mid and higher-level staff (e.g., managing reporting requirements, management skill building, interpreting analytics, audit preparation, and structuring recoveries).

  • Insights on building your SIU and the evolution of your team for the SIU of the future.
  • How is your SIU partnering in innovative ways to help prevent fraud (e.g., medical directors, PBM, credentialing)?
  • How are you applying AI and machine learning to your team’s work?
  • What are innovative ways to be preventative?

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Clinical Issues for the Healthcare Fraud Investigator

Submissions in this category should advance an investigator’s clinical understanding of health care fraud. The ATC Committee is interested in expanding the understanding of par and non-par providers, and credentialing.

  • Understanding the types of provider credentialing
  • Par and non-par provider schemes
  • Behavioral health schemes
  • Physical therapy, occupational therapy, speech therapy
  • Medical necessity determinations & fraud
  • Prior authorization – impacts on fraud case
  • Using claims history to validate services
  • ID of high member utilization
  • ID of medical waste – provider driven vs member driven
  • Patient harm
  • Provider/ employer group fraud
  • Genetic testing

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Pharmacy Fraud Schemes

Submissions should include information, such as: how did the investigation begin, what were the red flags, how did you work the case, and how did you partner with other stakeholders in the anti-fraud community (e.g., local and state law enforcement, health insurer). 

Special Note: For any submissions focusing on opioids, we are looking for submissions that address the evolution of opioids and other controlled substances. Who can provide a clinical analysis of opioids and other controlled substances? What are the new delivery methods?

  • Pharmacy collusion
  • Physician over-prescribers
  • Data mining and monitoring to detect opioid abuse
  • Compounding
  • Pharmacy management programs
  • Telemedicine/ telefraud
  • Working with your PBM – investigating/ reporting
  • Diversion paired with services not rendered

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Fraud in the Government Programs

Submissions should discuss the schemes and challenges unique to the Medicaid and Medicare programs. Case studies and presentations in this category should examine fraud issues such as MCO Medicaid fraud, home health fraud, and hospice fraud.

  • Collaboration/ best practices among states, federal and MCOs   
  • Fraud schemes in Medicare Part D or Part C
  • Special issues in dual eligible populations
  • Qui tams (e.g., the value for MCOs, referrals for multi-state jurisdictional cases)  
  • Non-credentialed providers
  • Ineligible members
  • Program Integrity
  • Long term care issues
    • Hospice
    • Skilled nursing facilities
    • Behavioral health (mental health)
  • Facility fraud – readmission billed as observation to avoid bridging/ denial

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Fraud in Specialty Products including Worker’s Compensation and Disability Insurance

These submissions should highlight strategies and surveillance activities for uncovering common schemes in supplemental products including disability insurance, long term care insurance, and workers’ compensation.

  • Home health, LTC, Hospice, Skilled Nursing Facilities (post-acute)
  • Workers’ comp
  • Disability
  • Vision schemes
  • Accident
  • Specified Disease
  • Indemnity Plans

Detecting and Investigating Dental Fraud

Examine investigative skills and schemes specific to dental insurance. Case studies that partner with law enforcement are encouraged in this track of content. 

  • Dental/ medical cross over
  • Medicaid dental fraud
  • Orthodontic schemes

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Deadline (April 30, 2020): EXTENDED

In order for your presentation to be considered by the ATC Planning Committee, abstracts must be submitted by April 30, 2020.

Who Should Submit:

We are interested in hearing from professionals in health care fraud detection, investigation, prosecution and prevention activities. The NHCAA Institute is proud of its tradition of offering the very best in health care anti-fraud education and training and welcomes your proposal.

Please share your knowledge, insights and expertise with the health care fraud investigative field. Working collectively to share and learn is the key to winning the fight against health care fraud.

Speaker Benefits

If selected to speak at the ATC, NHCAA agrees to non-transferrable conference registration and travel reimbursement for up two speakers per session. Travel reimbursement includes one-night hotel (room and tax only) and up to $500 for transportation (airfare and ground included). NHCAA does not reimburse for incidentals or meals for the ATC.

Sponsorship and Exhibiting Opportunities:

If you are interested in sponsorship or exhibit opportunities at our Annual Training Conference or a National Education and Training Series (NETS) program, please contact Bridgid Myers at bmyers@nhcaa.org.

For more information and to be added to the Call for Presentations email announcements, email training@nhcaa.org.

Deadline to submit is Thursday, April 30 - EXTENDED.