Behavior Change, A New Approach to defeating Fraud, Waste, and Abuse

  • September 21, 2016
  • 2:00 PM – 3:00 PM ET
  • Online
about

Fraud, Waste, and Abuse (FWA) is a continuing problem for all healthcare payers.  The size, persistence, and growth of the problem suggests that a new approach is needed.  This webinar will present the case for a new approach in which the goal is to effect a pre-pay behavior change rather than post-pay enforcement and recovery.  The benefits of a successful pre-pay behavior change solution include a cost effective impact on small FWA, “high tech, low touch”, i.e. technology over professional staff, dollar for dollar savings versus pennies on the dollar recovery, and network effects.

What you’ll learn:

  • Understand how behavior change is pertinent to solving the FWA problems
  • Understand the cost of small dollar FWA and understand how and why behavior change can reduce the impact
  • Understand the features needed to effectuate behavior change
  • Understand why escalation is critical

Who should participate:

  • Employees of health insurance plans and health care organizations
  • Managers and staff working in special investigation units (SIUs)
  • Corporate counsel and legal advisors
  • Compliance officers
  • Claims analysts
  • Fraud examiners
  • Federal and state regulatory personnel
  • Others in related fields who seek more knowledge in fraud investigation

Speaker:


Franklin M. Din, DMD, MA is Chief Medical Information Officer for FraudLens, Inc. and is responsible for developing advanced healthcare fraud detection and prevention based on a behavior change approach in conjunction with the principals of “Broken Windows”.  He brings experience, expertise, and knowledge in clinical care, healthcare policy, forensics, and biomedical Informatics, to lead a team of software engineers, HIT experts, visualization and user interface developers to produce unique software solutions that address the most perplexing healthcare issues.  He successfully designed and developed the powerful yet easy to use fraud detection solution, FraudLens.   Prior to co-founding FraudLens, Inc., Frank worked for HP Enterprise Services, as Executive Director of the Medical Informatics Center of Excellence (MICOE) and the Medical Informaticist for HP Enterprise Services global eHealth Strategy team.


Training That Gives You Real Credentials

The Health Care Anti-Fraud Associate Designation (HCAFA) designation helps you understand types of health insurance fraud and abuse — including provider, consumer, Agent & Broker, and employee fraud. To acquire the HCAFA designation, you must pass both the Fraud, Parts I and II courses, and view one Anti-Fraud webinar. Start Earning Your Anti-Fraud Designation Today.

The on-demand version of this webinar will be eligible for credits towards The Health Care Anti-Fraud Associate Designation (HCAFA). More information will be provided after the live session.