Fraud, waste and abuse (FWA) is a $240 billion problem in the U.S. When fraudulent claims are paid, healthcare insurers are left out of pocket, trying to be reimbursed after payment. Estimates are that only five to ten percent of fraud is intercepted, according to the National Health Care Anti-Fraud Association. With increasingly complex schemes, it’s getting harder to eliminate FWA with traditional payment integrity solutions.
In this webinar, Mastercard will explain how to increase the identification and prevention of FWA with AI, significantly reducing inefficient pay-and-chase activities and moving toward a prevent and save business model. With increased detection of true FWA, false positives are greatly reduced, anomaly detection is significantly increased, and payers’ investigators can focus their time on highly-likely FWA. We will explain how a proven AI solution leverages experience in payment fraud to complement claim fraud mitigation and how this technology creates prospective (pre-pay) models built by identifying anomalies found in historical claims data (post-pay).
VP, Healthcare Product Development and Innovation
Beth leads Mastercard’s Healthcare Vertical with the Cyber and Intelligence team. Beth manages the healthcare fraud and AI business, building upon the healthcare payment solutions she previously managed at Mastercard. Beth was recognized by Becker’s Hospital Review as one of 110 Women in MedTech to Know in 2017. She previously served as the Chief Marketing and Product Officer for Health Payment Systems where she was responsible for the strategic positioning of HPS and led the company’s marketing, consumer engagement and product development efforts. Beth has over 30 years of experience in the financial services and the healthcare technology industries.
Tim McBride, AHFI
Director, Healthcare Product Development and Innovation
Tim leads Mastercard’s Healthcare Fraud Waste and Abuse Vertical within the Cyber and Intelligence team. Tim is an accredited Health Care Fraud Investigator 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. Tim has over 23 years of experience in the healthcare payment and technology industries with Mastercard, Verscend Technologies and other smaller TPA’s.
Jala Attia, MBA, AHFI, CFE, CHC
Jala is a healthcare fraud, waste and abuse (FWA) expert with nearly two decades of detection, investigation and program oversight experience. She has served in a number of roles at health plans and technology vendors where she was responsible for building and cultivating a multi-million-dollar program integrity services team that supported dozens of Medicaid, Medicare, and Commercial plans. Jala also created the strategic focus for post-payment and pre-payment fraud waste and abuse applications in support of health payers around the country.