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Artificial Intelligence: The Secret
Superpower of FWA Investigators

  • March 31, 2021
  • 2:00 PM – 3:00 PM ET
  • Online
about

Health care insurance providers are faced with the challenge of finding new and proven innovations to help identify fraud, waste and abuse (FWA). The most prevalent and talked about technology today is artificial intelligence (AI), yet few investigators understand how it can help and what tools it uses to address these challenges. Instead, many rely on legacy technologies that often lead to high false positive rates and payment of fraudulent claims. As a result, there are over $300B in annual FWA losses in the U.S. alone.

This webinar will demystify how AI augments existing special investigations unit (SIU) methods with self-learning models that work in real time. Join two accredited health care fraud investigators who will explain how AI supports existing FWA practices and provide examples of use cases. Learn how advances in AI are proven to effectively detect FWA, prevent payment of false claims, and allow investigators to work more efficiently.

Attendees will learn how AI:

  • Detects health care fraud, waste and abuse more efficiently and effectively than legacy technologies
  • Identifies fraud before the claim is paid, preventing the “pay-and-chase” cycle
  • Helps SIUs achieve higher detection rates and fewer false positives so they can focus on more complex FWA schemes
  • Efficiently assesses new providers to reduce onboarding risk
  • Continuously monitors provider behavior and risk levels

Speakers


Tim McBride
Accredited Healthcare Fraud Investigator (AHFI)
Director of Healthcare Product Development & Innovation
Mastercard

Tim McBride, AHFI, leads Mastercard’s healthcare fraud, waste and abuse vertical within the Cyber and Intelligence team. Tim is an Accredited Healthcare Fraud Investigator and is responsible for managing the creation and development of FWA solutions for healthcare using artificial intelligence.

Prior to joining Mastercard, he served as an Investigator and Product Manager for Verscend Technologies (formerly Verisk Health) within the fraud solutions team where he was responsible for algorithm and product development efforts. While at Verscend, Tim worked very closely with several large and medium to small payers gaining a good understanding of market needs and processes, translating those needs into requirements for the consumption of developers and data science teams. He also oversaw the delivery and training of new products.

Tim has more than 23 years of experience in the healthcare payment and technology industries.


Jessica Gay
Accredited Healthcare Fraud Investigator (AHFI)
Vice President and Co-Founder
Integrity Advantage

Jessica has been in client service leadership roles for more than 17 years, with a decade spent in health care fraud, waste and abuse as a business partner to more than 25 health payers and several vendors.

Jessica’s expertise is in medical coding and data analytics for strategic planning, coding accuracy audits, medical record review and training. She serves as a liaison between business and technical staff, translating user needs in order to drive development and efficient implementation of industry leading fraud waste, and abuse solutions.

Using her knowledge as a subject matter expert and medical coder, Jessica also led a number of initiatives involving anti-fraud product development and enhancements. Her ability to share best practices, create customized solutions, and foster professional relationships in support of the fight against fraud, waste and abuse has earned her a place as a trusted industry thought leader.

Jessica is a Certified Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AHFI), and Certified Fraud Examiner (CFE).

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