Research has shown that fraud, waste and abuse costs the healthcare system billions of dollars every year. Today, we have access to more data than ever before. Health and dental plans must look for evidence-based solutions to reduce FWA-related health care costs. Having a comprehensive FWA program that ties up-front edits and analytics with investigative findings holds the potential to contain rising healthcare costs through better prevention, identification and reporting.
Today’s health and dental plans are challenged during state and federal fraud waste and abuse (FWA) audits to successfully define and convey the full scope of all of their cost-saving FWA activities. These activities often reside in multiple departments within health plans, and need to be expanded and reported to present a full picture. This often results in unfavorable audit findings because plans are either doing less than expected or reporting on fewer accomplishments.
Audit requests are often too narrow to uncover all FWA initiatives being undertaken by health plans. This webinar will explore the changing landscape of how health and dental plans utilize preventive analytics and edits, pre-payment, medical necessity, and retrospective auditing to capture all FWA activities. Furthermore, these activities will be explained in the context of fraud, waste and abuse definitions.
Attendees will learn:
Who should attend: General Counsels, Compliance Officers and Special Investigations Unit VPs, Directors, and Managers
Nicholas Messuri, Vice President, Fraud Prevention & Recovery
Nicholas J. Messuri is Vice President and Deputy General Counsel for Fraud Prevention & Recovery at DentaQuest in Boston, MA. He is responsible for overseeing a team of dental investigators and managing a national anti-fraud and abuse program for Medicaid, Medicare Advantage and Commercial membership. Previously he was Director of Fraud Prevention & Recovery at Tufts Health Plan.
Mr. Messuri began his 30-year legal career with a seven-year term as an Assistant District Attorney followed by 13 years as an Assistant Attorney General, including a 10-year term as Chief of the Massachusetts Attorney General’s Medicaid Fraud Division.
In 2004, Mr. Messuri was appointed Chief of the Business & Labor Crimes Bureau. As the Commonwealth’s chief health care fraud prosecutor, his Medicaid Fraud Division recovered millions in restitution and obtained civil judgments and convictions against providers for a variety of health care fraud and abuse schemes including billing for services not rendered, billing for medically unnecessary services, up-coding services, providing substandard care and causing false health care claims.
In 2005, Mr. Messuri was appointed President of the National Association of Medicaid Fraud Control Units. In addition, he is a past Chair of the National Association of Attorneys General Multi-State False Claims Act Committee. He has testified before the United States Senate Finance Committee on improving Medicaid fraud control initiatives, and is a frequent health care fraud enforcement writer and speaker for the American Health Lawyers Association.
In 2012, the Centers for Medicare & Medicaid Services appointed him the first Co-Chair of the National Health Care Fraud Prevention Partnership’s Information Sharing Committee. In 2015, Mr. Messuri was elected Board Chair for the National Health Care Anti-Fraud Association, the non-profit national public/private organization focused on prevention and investigation of health care fraud and abuse.