Detecting Healthcare Contractual Fraud, Waste, Abuse and Non-compliance - Detection, Auditing, and Oversight
Friday, July 19, 2013 from 10:00 AM to 11:30 AM (PDT)
This healthcare compliance training will help you understand the framework of healthcare contracts, the contractual or contracting risk areas, areas of actual and potential financial exposure, and various detection tools and techniques. You will learn to detect and eliminate ambient back door losses via contracting malfeasance.
Why Should You Attend:
This managed care compliance and risk analysis webinar will discuss the often overlooked but serious risk areas in the oversight of managed care contracting, network development, provider relations, business development and marketing. Within the webinar, key risk areas, methodologies for detection and investigation, and for ongoing oversight and auditing will be presented. This webinar will start from reviewing the various Provider and Payor and vendor methodologies and models, process flows, and risk areas that can and do exist. We will then review how the various models will lead to what kinds of fraud, waste or abuse. We will then discuss detection methods and processes for detection and investigation.
Finally, proactive audit and prevention tools will be discussed and presented to allow the finance and or compliance executive to prevent such issues or to detect them early in the contracting cycle.
Areas Covered in the Webinar:
- Types of Fraud, Abuse, Waste, and Non-Compliance, potentially present in managed healthcare organizations
- Typical processes and risk elements in healthcare contracting and how various models may encourage or discourage or prevent fraud, waste or abuse
- How to conduct various levels of contractual and network risk analysis to detect fraud, waste or abuse
- Various types of Managed Care Health Plan, Provider Contracts and Methodologies.
- CMS Contractual Standards
- Elements of a Contracting Oversight Audit and or Risk Analysis will be explained
- Real World examples of malfeasance and contracting fraud and abuse within managed care and related marketing will be presented
- Typical policy considerations for preventing fraud, waste, abuse in contracting and network development areas
- We will discuss how to use Risk Analysis to deal with difficult compliance issues, such as conflicts of interest
- Tools to be used for policy management and documentation will be presented
- How to adopt policies, train on them, and conduct drills on them will be discussed.
At ComplianceOnline, we are focused on :
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- Keeping things simple and straight forward , so that we all can indeed improve the quality of our processes, our work, our businesses and enhance compliance globally.
- Being inclusive, giving the process experts ( & novices! ), compliance professionals, quality champions, and regulatory agencies a voice so that all of us can contribute and make a difference.