Do you have a health care anti-fraud skill or scheme to share? Can NHCAA members learn from your experiences or your expertise?
Submit a presentation idea to lead an educational session during 2027! This call for presentations is for NHCAA’s Skills, Schemes, and on-demand sessions.
We’re looking for:
- Anti-fraud professionals at all career stages – we can learn from your years of experience or your fresh perspective.
- Experienced and non-experienced speakers – wow us with your well-tuned presentation skills or work with NHCAA staff to sharpen your presentation style.
- Diversity of perspectives – we want to hear from analysts, investigators, managers, clinical staff, and others from different lines of business, geographic areas, and plan sizes.
- Presentations that that offer lessons learned, tips to identify schemes, case studies, technological innovations, cross-sector collaboration, or insights that expand your peers’ skills.
Prepare for the CFP by defining the goals of the presentation, creating a well-written and succinct presentation summary, identifying speakers, and determining the target audience for your presentation.
Use the “submit here” links to share your idea for NHCAA’s 2027 Programs!
Enhancing Your Skills: Managing & Navigating Complex Investigations
Virtual Program | March 2 – 4, 2027
Credits: 10 CPE
Submission Deadline: September 30
Enhancing Your Skills is designed to help health care fraud investigators and analysts strengthen the practical competencies they use to manage complex investigations. We are seeking interactive, application-focused presentations that move beyond general awareness and show participants how to perform a task, make a decision, analyze information, or produce a stronger investigative outcome.
Strong proposals will incorporate real-world examples, demonstrations, scenarios, guided exercises, or reusable resources. Presentations should provide a clear process or decision framework that participants can apply within their own organizations.
We are particularly interested in proposals addressing:
- Investigative Strategy and Decision-Making — Lead triage, prioritization, investigative planning, research strategies, escalation decisions, and navigating situations in which multiple approaches may be valid.
- Analytics and Data Interpretation — Identifying meaningful outliers, evaluating false positives, establishing thresholds, prioritizing leads, using Excel or other accessible tools, and translating analytics into investigative action. These sessions should be geared toward investigators, not analysts.
- Interviewing and Negotiation — Advanced interviewing techniques, active listening, deception indicators, difficult conversations, provider or member interviews, and negotiation strategies.
- Documentation and Case Development — Organizing evidence, documenting investigative decisions, writing findings, developing defensible case narratives, and preparing matters for referral, filing, or prosecution.
- Clinical and Coding Literacy — Helping non-clinicians interpret medical records, diagnosis and procedure codes, documentation, medical necessity, and clinical indicators relevant to an investigation.
- Applied AI and Emerging Technology — Demonstrations of appropriate investigative uses of AI or automation, including verification, limitations, governance, and documentation of AI-assisted work.
- Collaboration and Investigative Outcomes — Coordinating investigators, analysts, clinical staff, legal counsel, compliance, government partners, and other stakeholders to move a case from lead to action.
- Integrated Case Study — Case walk-through that details decision making and challenges of the case, which could include data analytics, coding/medical record review, interviewing, and case resolution.
What we are looking for
Priority will be given to proposals that:
- Teach a transferable investigative or analytical skill.
- Include a real-world example, demonstration, scenario, or guided exercise.
- Move beyond describing the scheme or investigation to explain how decisions were made and how the work was performed.
- Address an intermediate or advanced audience while providing enough context for less-experienced participants.
- Provide a practical takeaway, such as a checklist, decision tree, worksheet, practice file, interview guide, documentation template, or referral framework.
- Include opportunities for participant questions, discussion, or application.
Schemes for Health Care Fraud Investigators & Analysts
Hybrid Virtual Live / On-Demand Program | June 1 – 11, 2027
14 CPEs
Submission Deadline: December 11, 2026
Join NHCAA’s annual Schemes for Health Care Fraud Investigators & Analysts program, designed to explore current and emerging health care fraud schemes. This virtual program combines on-demand presentations, live sessions, and networking opportunities to help investigators and analysts understand how schemes operate, recognize suspicious patterns, and strengthen their investigations.
We welcome presentations that explain the structure and mechanics of a particular scheme, examine a new or changing fraud trend, demonstrate a detection or investigative method, or share lessons from an actual investigation. Whether explaining how a scheme works or showing how it was uncovered, presenters should provide practical information that helps participants recognize and investigate similar activity.
Topics of Interest
We are particularly interested in proposals addressing:
Emerging and Evolving Fraud Schemes — New schemes, changing billing patterns, coordinated fraud activity, complex provider relationships, and methods fraudsters use to adapt to payer or enforcement controls.
DME and Medical Supply Schemes — Fraud involving wound-care products, skin substitutes, orthotics and bracing, respiratory equipment, sleep-related services and supplies, catheters, mobility equipment, or other high-volume and high-cost items.
Pharmacy and Drug-Related Fraud — Electronic prior authorization manipulation, specialty drugs, compounded products, 340B risks, pharmacy or PBM ownership relationships, prescribing practices, and other emerging pharmacy schemes.
Behavioral Health and Substance Use Disorder Schemes — Billing and documentation concerns, medical necessity, patient recruitment, psychotherapy, treatment programs, adult day care, and challenges associated with behavioral health services.
Provider Fraud and Hidden Relationships — Phantom providers, shell entities, collusion, identity or NPI misuse, kickbacks, illegal self-referrals, undisclosed ownership, and other nonobvious provider relationships.
Medicare Advantage and Risk Adjustment — Schemes involving diagnosis reporting, risk scoring, documentation, provider incentives, suspect coding patterns, or other fraud risks associated with Medicare Advantage payment.
Clinical, Coding, and Medical Record Issues — The role of medical records, coding, clinical indicators, templated documentation, and medical-necessity review in identifying or investigating suspicious activity.
Data Analytics and AI in Scheme Detection — How claims data, external data, link analysis, artificial intelligence, or other analytical techniques can reveal suspicious patterns, relationships, billing behavior, or emerging risks.
Complex and Coordinated Fraud Activity — Multi-provider, interstate, cross-border, or organized schemes involving multiple individuals, entities, specialties, payers, or jurisdictions.
Traditional Fraud Areas with New or Changing Tactics — Developments involving laboratories, telehealth, identity theft, medical tourism, outpatient facilities, home health, hospice, dental services, or other established fraud areas.
Investigative Tools and Techniques — Approaches for identifying red flags, researching providers and business relationships, reviewing records, connecting data to other evidence, or addressing barriers encountered during an investigation.
From Detection to Action — Methods for translating findings into payment action, recovery, referral, prosecution, or another appropriate outcome.
Strong proposals will help participants understand how a scheme operates, what makes it difficult to detect or investigate, and what indicators may signal similar activity. Presentations may focus on the mechanics of a scheme, an emerging trend, a detection method, an investigative approach, or an actual case. Relevant codes, billing patterns, data indicators, documentation concerns, red flags, practical examples, and lessons learned are encouraged whenever applicable.
- Foundational topics for those new to the industry:
- Coding and Clinical topics
- Government Programs
- Investigative Skills
- Investigative Strategy
- Reporting & Documentation Best Practices
- Scheme Breakdowns
- Scheme Walkthroughs or Case Studies such as:
- Behavioral health
- Benefit Design Manipulation
- DME
- Home health
- Labs
- Pharmacy, etc.
- Analytics & Tutorials:
- Analytic Strategies
- Dashboards & Data Visualization for Investigations
- Incorporating Open Sources in Analytics
- Red Flag Detection in Small Data Environments
- Tutorials, such as:
- Access
- Excel
- PowerBI
- Python
- Tableau
NHCAA’s 2026 Annual Training Conference
November 3–6
San Diego, CA
The Call for Presentations is now closed.
