RN, MBA, CCM, CFE, CPC, CHS-111, CRMA, CICA, FIALCP, FHFMA
CEO, Medical Business Associates, Inc.
Book Author of “Healthcare Fraud: Auditing & Detection Guide”
Faculty member of the Association of Certified Fraud Examiners
Head of Anti-Fraud, Investigations and Medical Audit
at Oman Insurance Company, UAE
Expert in fraud management and a demonstrated history
of working in the global insurance industry Worked at:
ADNIC, Deloitte, KMPG, EY as Anti Fraud Expert
This course is designed to introduce the healthcare/insurance industry: a highly segmented market with high-dollar cash transactions, from a fraud, audit, and detection perspective. This course teaches, “what is normal” in the marketplace so that abnormalities become apparent. Healthcare/Insurance fraud prevention, detection, and investigation methods are outlined, as are different types of healthcare schemes, red flags to spot these schemes, and how Healthcare/ Insurance fraud is ultimately stopped.
The course also provides exposure to the latest emerging technology trends and their application to optimize the fraud investigation. The course is embedded with several interactive practical case studies that illustrate to the audience how the fraud investigation techniques can be practically applied in a real-time environment. The ultimate goal is to encourage participants to see beyond the eclipse created by Healthcare/Insurance fraud and sharpen audit and investigation skills to identify incontrovertible truth.
After attending this course, participants will return with new knowledge and be able to:
This program is appropriate for analysts, corporate executives, healthcare professionals, investigators, internal auditors for hospitals, medical offices and other health care organizations
Book & pay on or before August 22, 2019
& get 10% discount USD 1,890/participant
Corporate (Group Discount)
5% Additional discount on minimum of 2 Participants
Oman Insurance Company was established in 1975 and is one of the leading insurance providers in the Middle East. A public stock company, we are listed on the Dubai Financial Market stock exchange. A financially sound company, Oman Insurance is A rated by AM Best and A- by Standard & Poor’s.
With GWP at 3.7 billion in 2018, Oman Insurance offers a wide range of insurance solutions for individuals and corporates in Medical, General (Property, Energy, Engineering, Aviation, Marine, Liability) and Life insurance. The company’s experience and expertise is widely recognized, as reflected in a number of awards received at industry forums, like Commercial Lines Insurer 2018, General Insurance Company 2017 and Health Insurance Company 2017 to name a few.
The company has strong operations across the UAE, with an intensive distribution network of branches, brokers, bancassurance partners, agencies and call center. The company’s geographic footprint also extends to Oman, with a subsidiary in Turkey.
Learn more about Oman Insurance Company on www.tameen.ae
Registration and Intro
I. Overview of fraud examination
II. ACFE practice standards
I. Implication of healthcare fraud and current global trends;
II. Spotlighting trends and emerging schemes in healthcare fraud;
III. Developing an anti-fraud culture and ethics
I. Fraud examination process
II. Advanced medical fraud prevention strategies
III. Medical audit/tools
I. Case study work session practical work and interactive exercises
Covered by (Mr. Shahzad Alam, Head of Anti Fraud, Investigations and Medical Audit Unit, Oman Insurance Company)
The Changing Landscape of Medical Insurance Fraud in the UAE and GCC Region
I. Conducting a comprehensive and integrated approach to healthcare fraud risk assessment (IIA Standards)
II. Medical fraud detection using advanced data analytics/data mining techniques
I. Healthcare insurance fraud challenges and its impact in Middle East
II. Healthcare fraud prevention
I. Combating healthcare FWA with new technology (AI, BLOCHCHAIN or etc.); leveraging technology;
II. Understanding health insurance regulations
I. Continued case study work session practical work and interactive exercises
|08:00 to 08:30||Registration & Introduction|
|08:30 to 10:00||Session One|
|10:00 to 10:15||Morning Break & Networking|
|10:15 to 12:15||Session Two|
|12:15 to 13:15||Lunch Break & Networking|
|13:15 to 14:45||Session Three|
|14:45 to 15:00||Evening Break & Networking|
|15:00 to 16:30||Session Four|
|16:30 to 18:00||Session Five|