Increasing Payment Efficiencies and Cost Savings with Identity, Claims and Fraud Detection Analytics

June 4, 2013
1:00 pm - 2:30 pm ET
Online

LexisNexis
 Presented by LexisNexis 

The United States now spends about $2.6 trillion annually on health care (17.5% of GDP) and with the reform initiatives under the Affordable Care Act (ACA), the number of Americans covered and the amount spent will grow dramatically, potentially leading to even greater fraud, waste and abuse in the system. Health care fraud is a concern for federal and state, as well as private insurance programs. The Federal Bureau of Investigations (FBI) has estimated fraudulent billings to health care programs, both public and private, at between 3 percent and 10 percent of total health care expenditures.

To date, success in stemming health care fraud, waste and abuse across commercial and government programs has been somewhat sporadic. As the costs associated with health care coverage reach unprecedented levels, traditional approaches to combating fraud, waste and abuse become less attractive.  Identity, claims and FWA detection analytics deployed in pre- and post-payment paradigms is critical to driving down costs and improving overall efforts to deter fraud, waste, and abuse. Understanding the evolving nature of fraud and its perpetrators involves looking beyond localized data. Incorporating public records data and the ability to tie risk attributes to the individuals interacting across your health programs provides intelligence that empowers plans to act with confidence.

Attendees will discover:

  • The cross functional role of identity analytics in a health plan
  • How to deploy claims, business rules and predictive analytics to drive down improper payments


SPEAKERS:

Clint Fuhrman, Senior Director Business Development & Public Policy

Clint Fuhrman is the Director of Government Health Care Programs for LexisNexis Risk Solutions. Mr. Fuhrman joined LexisNexis in 2009 after serving as Deputy Secretary of the Florida Agency for Health Care Administration. During his time at AHCA, Mr. Fuhrman helped direct Agency strategy and operations in the areas of legislative affairs, communications, Medicaid policy, and health information technology. He was appointed by Governor Charlie Crist to the board of the Florida Healthy Kids Corporation in 2008.

Mr. Fuhrman has over 10 years of experience in the government, health care and political fields. He served as Special Assistant to Governor Jeb Bush from 1999-2002, and represented a wide range of clients before the Florida Legislative and Executive branches as Director of Legislative Affairs for The Rubin Group and President of Meridian Consulting Group. Mr. Fuhrman has extensive grassroots and statewide campaign experience, having served with the Republican Party of Florida, the Republican National Committee, and the Charlie Crist gubernatorial campaign, among others. Mr. Fuhrman began his career with the Florida Institute of Government at Florida State University, and is an FSU graduate. He currently resides in Washington, D.C., and is a native of Pensacola, Florida.


Ken Cunningham, VP of Analytics

Ken Cunningham is Vice President, Analytics, for the risk solutions business of LexisNexis®. He is responsible for overseeing the development of analytics to help insurance carriers improve their claims payment processes, including avoiding fraud and subrogation losses, among other problems.

He joined LexisNexis in 2005 from Magnify, where he worked alongside the founder to implement business strategies for advanced predictive modeling. In this capacity, he worked in credit card fraud identification, e-mail targeting, and insurance carriers. With more than 30 years business and risk solutions experience, Cunningham has also worked as Senior Vice President for Bank of America, Managing Director at Continental and Managing Director at Mitsubishi Financial International.

Cunningham earned his bachelor’s degree in economics from Colorado College.

 

The content presented in this webinar is solely attributable to the speaker and does not represent an endorsement by America's Health Insurance Plans (AHIP) of the accuracy of the information presented in the audio conference or any opinion expressed by the speaker.