Advanced Medical Fraud Interviewing Techniques and Behavioral Analytics Training Workshop

March 24-25, 2019, Hotel Towers Rotana Dubai, UAE

Training Objectives

  • What is the theory behind effective forensic interviewing?
  • Effective planning as to the sequence of persons interviewed
  • Who can get us closest to our goal of understanding the fraud?
  • Relationship analysis to determine the potential players and bad actors
  • Where do we interview the potential bad actors?
  • What attitude do we take?
  • The correct way to ask questions
  • Finding a common ground to gain cooperation
  • How to deal with angry persons or those reluctant to talk
  • Body language with examples
  • Group discussions as to previous experience and how they could have been improved
  • What points to cover?
  • Evaluation of the level of stress observed
  • After the fact evaluation of the interview
  • Diffusing alibis
  • We will review 15-20 examples/sample together and as small groups
  • We will review the basics of behavioral analytics in healthcare fraud
  • How does a fraudster think?
  • We will review several large fraud cases and how they were handled with the outcomes and the pros/cons of each
  • We will discuss the legal issues associated with health care fraud investigations
  • We will review various cases using different types of providers and discuss how they could have been improved
  • We will let the group interview one another in small groups and/or discuss how to plan for an  effective interview
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Instructor of this course

Robert D. Church

CPA, CFE, AHFI, CFF
Healthcare Forensic FWA Expert
Forensic Investigator 
Proficient in Analytics (Data, Behavioral and Predictive)
Have recovered over $1.4B in fraud and abuse monies,
working with federal and state agencies and attorneys

 

More Detail

The United States Office of Inspector General, division of Health and Human Services has just recently announced that healthcare fraud recoveries are DOWN almost $2B in 2018 from recoveries in 2017.  They indicate it is as a result of smaller settlements being received, but that really can only address a part of the reason for the significant decline.   The methods by which cases are investigated, appropriate resources and understanding the behaviors underlying fraud also contribute heavily. Understanding the mindset of healthcare fraudsters, the methods used to learn the tricks and trends are also important. These keys lead to becoming knowledgeable in the areas of behavioral analytics and interviewing techniques so that the best information is extracted.   
The business of healthcare fraud has become so prevalent that we must understand the mindset, but we also must address the profiles of fraudsters and their mannerisms, their explanations, and their body language to be the best we can be in uncovering fraud and abuse.  We must know how to truly conduct forensic interviews, what to ask, what not to ask, how to not tip your hand, how to gain cooperation and form relational boundaries through which to gain vital information associated with fraud and abuse. This extends to studying body language and “lie spotting”.  Interviewing effectively is critical in any fraud case and this can lead to becoming expert at the deposition and testimony levels, as well.
This course will review the theory and application of effective forensic interviewing, venues for best results, the processes by which we interview and the procedures, the techniques for asking open-ended vs. closed-ended questions, who to interview first, the means by which to determine deception, appropriate planning, monitoring eye contact and body movements as well as the target’s culpability in the fraud.

You will leave this course with an advanced understanding of the critical nature of effective forensic interviewing in healthcare fraud and abuse matters, a better understanding of body language and deceptive behavior, including:

  • General behavioral analytics
  • False Claims
  • Anti kickback
  • Stark
  • Interviewing skills
  • Planning effective interviews
  • The power of emotions
  • The human factor in healthcare fraud
  • Key interviewing techniques beyond the basics
  • FWA investigators
  • FWA analysts
  • SIU investigators
  • Payment integrity analysts, managers 
  • Compliance analysts and managers
  • Internal and external auditors
  • Medical audit/claims
  • Consultants
  • Those new to the fraud and abuse world

Third party Administrator (TPA) companies
Healthcare Insurance/Takaful Companies
Healthcare Reinsurance Companies
Insurance/Healthcare Insurance Councils/Associations/Authorities
Healthcare Ministries, Authorities and Medical Cities
Hospitals and Medical Centers

 

  • Presentations & lectures
  • Group discussion
  • Exercises & use cases
  • Certificate of achievement
  • Course material
  • USB with all material
  • International buffet lunch with coffee/tea breaks

Course Fee $1,840/Participant

Individual
Book & pay on or before Feb. 28th , 2019
& get 10% discount USD 1,656/participant

Corporate (Group Discount)
5%
Additional discount on minimum of 2 participants


Advanced Medical Fraud Interviewing Techniques and Behavioral Analytics - Course Schedule

Day 1 - Sunday 24 March, 2019
Opening Session

Registration and Intro

Session One

The Basics of Forensic Interviewing

  • Planning the interview
  • Who to interview first
  • What to ask and how to ask it
  • Building a case
  • Understanding the relationships; who are our potential bad actors
Morning Break & Networking
Session Two

The Basics of Forensic Interviewing 

  • Who could have culpability
  • Body language and detection of deception
  • Finding common ground
  • Dealing with angry or reluctant interviewees
 Lunch Break & Networking
Session Three

Examples and Round Table Discussions

  • Reviewing examples 
  • Open discussion of experiences and successes
  • Actual interviews within the group
 Evening Break & Networking
Session Four

Examples and Round Table Discussions

  • The theory and application of interviewing principles
  • The processes and procedures in building a case
Day 2 - Monday 25 March, 2019
Session One

Behavioral Analytics

  • Evaluating and measuring the results of interviews
  • Where to go next?
  • How does a fraudster think?
  • Where does the fraud triangle fit?
Morning Break & Networking
Session Two

Behavioral Analytics

  • The power of emotions and when honesty reverses course
  • Accusations? 
  • Disclosing key pieces of information
  • Various techniques to employ as needed depending on how the interview goes
Lunch Break & Networking
Session Three

Legal Issues In Healthcare Fraud Investigations, Example Cases Using Varied Provider Types, Laws Surrounding Healthcare Fraud And Abuse

  • Where do the legal issues start and finish in an investigation?
  • How do we know when to call the lawyers? 
  • What if they request counsel?
  • What rights does a fraudster have?
 Evening Break & Networking
Session Four

Legal Issues in Healthcare Fraud Investigations, Example Cases Using Varied Provider Types, Laws Surrounding Healthcare Fraud And Abuse

  • Group review of key cases involving ƒ
    • Psych Services ƒ
    • Critical Access Hospitals ƒ
    • “Consulting Services” ƒ
    • Dental Services through Medicaid ƒ
    • Radiation Oncology ƒ
    • Transportation
  • False Claims Act Specifics
  • Ant kickback Related to Specific Fraud Case
  • Application of laws in unusual ways
  • Group discussion and Q&A
Course Program
Time Topic
Day 1
08:00 to 08:30Registration & Introduction
Day 1-2
08:30 to 10:00Session One
10:00 to 10:15Morning Break & Networking
10:15 to 12:15Session Two
12:15 to 13:15 Lunch Break & Networking
13:15 to 14:45Session Three
14:45 to 15:00 Evening Break & Networking
15:00 to 16:30Session Four