Jan
29
3:30 PM15:30
Nov
6
to Nov 9
Visit us at Booth 314 at the NHCAA ATC
Taming the healthcare FWA frontier requires multi-faceted expertise combined with proven strategies to harness ROI. Swing by Booth 314 and let us show you how our SIU services are roping in FWA success around the country. In addition, enter to win a gourmet steak bundle from 44 Farms Ranch!
Don't be left in the dust, join us in Dallas at the NHCAA ATC!
Oct
19
1:30 PM13:30
Urine Drug Testing - The Gift that Keeps on Giving
Earn 1 NHCAA and 1 AAPC Credit Hour!
Urine Drug Testing (UDT) is a scheme that continues be an issue for many FWA teams. Join Integrity Advantage experts to dive into data analysis techniques used to identify suspicious behavior and red flags in documentation that can be found during medical review.
Sign up today, space is limited!
Jul
31
3:40 PM15:40
Conquering Compliance with a Small (But Mighty) Team
NAMPI Session: Jala Attia will be presenting with Mark Starinsky from Shift Technology in Scottsdale, AZ. Join us live or virtually. Learn More.
May
1
to May 12
Virtual presentation: Unzipping Genetic Testing Fraud Waste & Abuse
Please join us at the virtual NHCAA Schemes for Health Care Fraud Investigators & Analysts conference.
Abstract
From 2016 through 2019, Medicare payments for genetic tests quadrupled. As scientists continue to make advancements in genetic testing, the landscape is everchanging. Unfortunately, bad actors can exploit the increased prevalence of genetic testing to obtain improper payments. This presentation will dive into de-identified data to show participants how to analyze their own data, using Microsoft Access and Excel, to uncover red flags. Red flags include lack of referring provider visit, repeated testing, and unqualified providers, among others we will discuss.
Participants Will Learn
How to use peer comparisons to identify outliers
How to use Microsoft Access to determine if members saw the listed referring provider
Rules and regulations surrounding genetic testing and tips to conduct a successful medical review
Participants will not only take away knowledge of genetic testing schemes, but also data analysis techniques they can use to uncover these schemes in their own data. Speakers will also showcase medical record examples to teach participants how to identify red flags in medical records.
Biographies
Jessica Gay, AHFI, CPC, CFE is the Vice President and Co‐founder at Integrity Advantage, a small woman owned business that specializes in payment integrity consulting and SIU services. She has been in leadership roles for nearly 20 years, with more than a decade spent in healthcare fraud, waste, and abuse as a business partner to more than 25 health payers and several vendors. Clients rely heavily on her expertise in SIU processes, data analytics and medical coding for strategic planning, coding accuracy audits, medical record review and training. Jess started in this industry as a trainer and loves the opportunity to speak and mentor like professionals. She has spoken at numerous NHCAA, ACFE and HCCA conferences over the years. Jessica is a Certified Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AHFI), and Certified Fraud Examiner (CFE).
Carlyn Hoffman, AHFI is a Senior Investigator with Integrity Advantage Solutions with seven years of experience in Healthcare FWA Investigations. Carlyn provides outsourced SIU services to health plans including data mining, lead generation, and investigations, Statistically Valid Random Samples (SVRS), and Audit Findings Reports (AFRs). Carlyn also has experience guiding health plans through casework from discovery through provider education and overpayment resolution. Carlyn previously worked as a Senior Investigator at Cotiviti, where she also trained clients and coworkers on Cotiviti’s FWA detection products suite.
Mar
29
1:00 PM13:00
Top 3 Critical FWA Program Pitfalls and How to Overcome Them
Top 3 Critical FWA Program Pitfalls and How to Overcome Them
As SIU’s continue to struggle with increased cases and less resources, many miss the pitfalls that exist within their program and organization. More importantly, they struggle to pinpoint actionable steps towards a solution. If this sounds familiar, you’re in luck! We've created this webinar for leaders and individual contributors, just like you, who strive to make an impact. Join us as we share valuable insights learned the long way from building and running an SIU, to conducting Program Assessments for plans across the country.
The National Health Care Anti-Fraud Association (NHCAA) has awarded this live webinar one (1) Continuing Professional Education credit towards the AHFI® designation.
Speakers
Jala Attia
President, Integrity Advantage
Jala Attia, AHFI, CFE, CHC is President and Founder of Integrity Advantage and has more than two decades of experience in healthcare fraud, waste and abuse (FWA) detection, investigation and program oversight. Jala served in various investigative and leadership roles at state, health plan and technology vendors where she built industry leading SIU teams and directed the development and enhancement of post-payment and pre-payment fraud waste and abuse applications for dozens of health plans. Currently, Jala leads an FWA services focused business that provides advisory and operational services to health plan clients in the development, improvement and growth of their fraud, waste and abuse programs. Jala chairs the Association of Certified Fraud Examiners (ACFE) Foundation Board and previously served on the National Healthcare Anti-Fraud Association (NHCAA) Board of Directors. She has developed healthcare FWA courses and currently is adjunct faculty for the Henry Lee College of Criminal Justice at the University of New Haven. Jala regularly speaks at industry conferences on topics related to healthcare FWA. Jala earned her BA from Rutgers University and an MBA from Georgian Court University. She is an Accredited Healthcare Fraud Investigator (AHFI), a Certified Fraud Examiner (CFE) and is Certified in Healthcare Compliance (CHC).
Jessica Gay
Vice President, Integrity Advantage
Jessica Gay, CPC, CFE, AHFI is Vice President and Co-founder of Integrity Advantage. She has been in client-service leadership roles for 20 years, with the last 12 years focused on the fight against Healthcare fraud, waste and abuse. With experience as a business partner to more than 30 health payers across all lines of business, clients rely heavily on her expertise in medical coding, investigations and data analytics for strategic planning, coding accuracy audits and training. Jessica often serves as a liaison between business and technical staff, translating user needs in order to drive efficient implementation of FWA analytics and case management. Her ability to share best practices, create customized solutions, and foster professional relationships in support of the fight against FWA has earned her a place as a trusted advisor to her clients. Prior to co-founding Integrity Advantage, she worked for a technology vendor supporting health payer clients to achieve results through the use of analytic FWA tools, training, consulting, data mining, investigation management and medical review support. Jessica is a Certified Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AHFI), and Certified Fraud Examiner (CFE).
Feb
16
2:00 PM14:00
NHCAA Webinar - Data Analytics Case Study
Elevating How You Communicate and Present Data by Giving Your Internal Clients Everything They Didn’t Know They Needed
1.5 CPEs
About This Webinar:
As data experts, analysts may shy away from communicating with their internal clients and providing more than what was on the original request. In this presentation, we cover why a mindset shift will make your job easier. Stop the guessing games! We’ll provide parameters for data presentation, which, like it or not, can be integral to information acceptance. Aiming to exceed expectations of the requester and using your expertise to take the next step is the secret sauce.
Speakers:
Jessica Gay, AHFI, CPC, CFE
Vice President, Integrity Advantage
Michelle (Rua) Wiedenhofer, PSM
Supervisor of Investigations, Analytics and Strategy, Integrity Advantage
Jan
1
1:00 PM13:00
Nov
16
11:30 AM11:30
National Health Care Anti-Fraud Association - Annual Training Conference
Tackling the Large, Multi-Specialty Provider Group Investigation
About the Session:
SIUs may avoid investigating large multi-specialty provider groups for various reasons. These types of investigations can be difficult to analyze and highly complex to sample. With large provider groups, there is also an elevated risk of provider abrasion, and the larger the group the more likely it is they serve a significant portion of the member population. This presentation shares why investigating these groups is important. The presentation will also include a step-by-step investigation of a large, multi-specialty provide group investigation from detection using data mining through sampling and record review.
Presenters:
Michelle (Rua) Wiedenhofer, PSM, Investigations & Analytics Consultant, Integrity Advantage
Jessica Gay, CPC, CFE, AHFI, Vice President, Integrity Advantage
Nov
16
10:15 AM10:15
National Health Care Anti-Fraud Association - Annual Training Conference
Investigative Quality: How to Ensure Your Team Produces High Caliber Work
About the Session:
When was the last time you took a hard look at the quality of work produced by your team? With the events over the last few years, teams have had to do more work with less resources, often sacrificing quality in order to handle higher volumes of work. Join us for this session where attendees will learn key questions to ask in evaluating investigative case quality, who should set those standards and why you need to raise the bar. We will discuss ways in which SIU leaders have successfully set metrics that accurately measure the caliber of investigative output from the receipt of a referral to the moment a case is closed.
Presenters:
• Harry Guglielmo, AHFI, Senior Director, Centene (Formerly Fideliscare)
• Jala Attia, AHFI, CFE, CHC, President, Integrity Advantage
Nov
16
10:15 AM10:15
National Health Care Anti-Fraud Association - Annual Training Conference
Protecting Payers Against the Risks of Digital Transformation
About the Session:
Annual healthcare expenditures in the U.S. totaled $4.1 trillion in 2020 – almost 20 percent of the GDP – with projections of $6.2 trillion in 2028. This massive system is vulnerable to fraud, data breaches and other illegal activities. Novel applications of machine learning and artificial intelligence are turning the tables on nefarious actors within the healthcare industry. The panel in this session will discuss how the latest technological innovations are helping uncover patterns and identifying FWA before claims are paid. Gain insight from the pandemic to prepare for the next big shift or change in the industry.
Presenters:
• Tim McBride, AHFI, Director of Healthcare Product Development and Innovation, Mastercard
• Jessica Gay, CPC, CFE, AHFI, Vice President, Integrity Advantage
• Adam Faurot, Chief Commercial Officer, SPEAR Human Performance
Nov
19
12:30 PM12:30
National Health Care Anti-Fraud Association - Annual Training Conference
Jala Attia and Jessica Gay will be presenting.
Leadership Workshop: Setting Goals for FWA Program Success
About the Session:
This session will cover five (5) types goals that that every FWA team should have in place and discuss specific examples of metrics that can be measured.
Nov
18
12:00 PM12:00
National Health Care Anti-Fraud Association - Annual Training Conference
Jessica Gay will be presenting.
Innovations in Payment Integrity: How AI Identified over $239M in FWA for One Healthcare Payer
Featuring:
Jessica Gay, Integrity Advantage
Tim McBride, Mastercard
David Cusick, Milliman
About the Session:
This session will explore FWA problems and challenges; how AI drives operational efficiencies; actual examples of how AI identified fraudulent providers; and how AI models produce scores of suspiciousness per provider that allow SIUs to take actions to save their organizations hundreds of millions of dollars.
Nov
16
12:30 PM12:30
Global Insurance Fraud Summit presented by Protiviti®
Jala Attia will be a panelist on the Global Insurance Fraud Summit presented by Protiviti®.
Panelists:
Dan Kreitman – Director of the Healthcare Fraud Prevention Partnership (HFPP)
Gary Cantrell- Deputy Inspector General for Investigations, HHS/OIG
Jala Attia – President and Founder, Integrity Advantage
Ronald Michel – Supervisory Agent at National Insurance Crime Bureau (NICB)
Commissioner Trinidad Navarro – Chair of the National Association of Insurance Commissioners’ (NAIC) Antifraud Task Force and Commissioner for the State of Delaware
About the Session:
This diverse panel of experts and thought leaders will discuss their personal observations, trends, and best practices by which you can best protect your organization and increase your collaboration across all your partners in addressing FWA. This invite-only event will feature more than 45 speakers and 30+ country updates on challenges, trends, best practices and regulatory insights specifically related to Insurance Fraud