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