Webinar: Advanced Healthcare Fraud Investigations, Interviewing Techniques and Behavioral Analytics

December 01-03, 2020, 11:00 AM – 3:40 PM, GULF STANDARD TIME (UTC + 04:00)

Training Objectives

Completion of this course will provide attendees with a better understanding of the scope of healthcare insurance fraud, and how to prepare a case with the proper order of interviews, ranging from the simplest situations to complex and sophisticated healthcare/insurance fraud crimes.  We will also discuss the differences between interviewing and interrogation and the proper setting for each. 

Participants will be able to:

  • Discern the best format for obtaining information from a witness, target, or subject matter expert
  • Learn techniques to determine if the interviewing is deceptive
  • How to plan interviews in the proper timetable for the full investigations?
  • a complex healthcare fraud case using behavioral and interviewing techniques
Register Now Download Brochure

Instructor of this course

Alanna Marie Lavelle

CEO and Founder, Lavelle and Associates, LLC, Atlanta, Georgia
Sr. Principal Consultant and Adjunct Professor
Former Chair of the Board and Faculty Member NHCAA
M.S., AHFI, CPC, ACFE

More Detail

This course will provide an advanced understanding of the critical nature of interviewing and interrogation in the Healthcare fraud, waste and abuse domain. Using case studies from the FBI and private industry, and the review of various types of federal statute violations, effective forensic interviewing will be studied, and introduced with role-playing by the attendees in the course. They will gain knowledge in planning effective interviews, key behavioral techniques to include active listening and recognizing salient kinesiology, detecting deception in interviews, and the “who-what-when-where-why and how much” in collecting witness evidence.

Completion of this course will provide attendees with a better understanding of the scope of healthcare insurance fraud, and how to prepare a case with the proper order of interviews, ranging from the simplest situations to complex and sophisticated healthcare/insurance fraud crimes.  We will also discuss the differences between interviewing and interrogation and the proper setting for each. 

Participants will be able to:

  • Discern the best format for obtaining information from a witness, target, or subject matter expert
  • Learn techniques to determine if the interviewing is deceptive
  • How to plan interviews in the proper timetable for the full investigations?
  • a complex healthcare fraud case using behavioral and interviewing techniques
  • Investigators and Auditors in the Healthcare domain
  • Certified Fraud Examiners (CFE)
  • Certified Information Systems Auditors (CISA)
  • Insurance Claims Adjudicators
  • Special Investigator Unit Directors/Auditors
  • Medical Claims Auditors
  • Attorneys
  • Third Party Administrators
  • Professionals who want to expand their skill sets in interviewing techniques
  • Fraud Analysts 
  • Compliance analysts and Managers
  • Internal and External Auditors
  • Medical Audit/Claims
  • Those attendees who are new to the fraud and abuse data analytics world
  • Group discussions focused on real-world case studies
  • Use of videos, images and brainstorming techniques for quality learning
  • Online quizzes
  • Daily feedback of previous day course activities
  • Interview exercises for each attendee
  • Course material
  • Certificate of Achievement

How can I register for Webinar and how does the whole thing work?

You may register by email or online: 

To register by email:

Download the brochure and complete the registration form given as a last page of the brochure and email to training@acsmb.com

To register online:

Step 1 – Go to the course page and click ‘Register Now

Step 2 - Complete the registration form, read and check the ‘terms and conditions’ box and click on ‘Register’.  You’ll receive a confirmation email.   

Step 3 - Click on ‘Confirm’ in the confirmation email and you'll be taken to the login page. Login and click the "Add to Cart" button that suits your needs and click "Pay by Credit Card" to enter your payment details.  You'll receive a payment confirmation email as well as a Welcoming Package with the full itinerary.

Please check following questions to see how the whole thing works.

If you have any questions or need assistance, please and thank you reach us at training@acsmb.com

How soon I can login?

You will be able to login 10-15 minutes prior to each activity/session. Don’t take a chance, so better will be to login early.

How do I join webinar/meeting?

Joining is easy, just takes few seconds.

Just click the link in the invite that you will be provided with in email. You will proceed to your session immediately. Just remember to register first if attending a webinar.

How can I join Zoom meeting and what are the pre-requisites?

Please check the details as how to join the meeting at https://support.zoom.us/hc/en-us/articles/201362193-Joining-a-meeting

How do I ask the Instructor questions?

There will be a 'chat option’ on your screen. Type your question in the box and send it direct to the Instructor. The Instructor will address your question at the earliest and at an appropriate time during the presentation

Course Fee $1,000/Participant

Early Bird Discount
10% discount till Nov 14, 2020 to pay $ 900/participant

Group Discount
10% additional discount on group of minimum 2 participants (from same organization)
20% additional discount on group of minimum 4 participants (from same organization)


Webinar: Advanced Healthcare Fraud Investigations, Interviewing Techniques and Behavioral Analytics - Course Schedule

Day 1 - Tuesday 01 December, 2020
Opening Session (10:45 To 11:00)

Opening Remarks  & Introduction

Session One (11:00 To 13:00)

The Basics of Healthcare Insurance Fraud

  • The Fraud Triangle
  • Types of Fraud, waste and abuse in healthcare
  • Identifying the potential interviewee and Defining Market Players within the Healthcare Continuum
    • The Patient
      • Who is the patient?What are some examples of patient fraud?
    • The Provider
      • Who is the provider? What are some examples of provider fraud?
    • The Payer
      • Who is the payer? What are some examples of payer fraud?
    • The Employer/Plan Sponsor
      • Who is the employer/plan sponsor? What are some examples of employer/plan sponsor fraud?
    • The Vendor and the Supplier
      • Who are the vendor and the supplier? What are some examples of vendor and supplier fraud?

Quiz

Break (20 minutes)
Session Two (13:20 To 14:20)

Dissecting the Case and Planning the interviews

  • The Order and Cadence of multiple interviews
  • Who, What, When Where, Why, How and How much?
  • The processes and procedures in building a case
  • Understanding the order and exigency of various interviews

Quiz

Break (20 minutes)
Session Three (14:40 To 15:40)

The Basics of Forensic Interviewing

  • Discuss strategies for structuring interviews
  • Discuss when and where to conduct interview
  • Types of witnesses:Whistleblower/Complainant; Patients, Former Employees, Office staff, Subjects, family members
  • Behavioral Profiling to assist in the interview setting

Quiz
End of day review and wrap up (Group Interactive Discussion)

Day 2 - Wednesday 02 December, 2020
Session One (11:00 To 13:00)

Review of previous day learning sessions, and basics and strategies discussed.

Behavioral Analytics

  • How to Think Like a Fraudster?
  • Planning and examining all potential outcomes of the interview
  • Doing your homework – assets, marital and financial status, bankruptcies/divorces/substance abuse
  • How to interview a Doctor with coders and attorneys present?

Case Studies and Round Table Discussions

  • Reviewing actual examples of successful interviews and failed interviews 
  • Open discussion of experiences and successes with witness and patient interviews:
    • Age, Gender, Loyalty to Doctor, Juvenile, Disabled, telephonic?
  • Role Play of witness interviews online
  • Role play of patient interviews online

Quiz

Break (20 minutes)
Session Two (13:20 To 14:20)

Behavioral Analytics and the Role of Ethics

  • The power of building rapport in the interview
  • Accusations or “breathing room?”
  • Setting the table
  • Possible techniques to employ for contingent circumstances during the interview

Quiz

Break (20 minutes)
Session Three (14:40 To 15:40)

Legal Issues in Healthcare Fraud Investigations

Safeguarding your case within the law

  • How a fraudster’s defense council can be your asset?
  • Avoiding Personal Health Information (PHI) in the interview
  • The legality of recording the interview:pros and cons
  • The importance of case documentation used during the interview
  • The use of analytics and a statistician/peer reviews and anomalous status

Quiz

End of day review and wrap up (Group Interactive Discussion)

Day 3 - Thursday 03 December, 2020
Session One (11:00 To 13:00)

Review of previous day’s concepts and strategies

  • Group review and role play of Subject interviews
  • The interview:a “non-accusatory conversation” vs an interrogation
  • Five obstacles to overcome in conducting a forensic interview
  • Five skill  sets to develop in conducting successful forensic interviews
Break (20 minutes)
Session Two (13:20 To 14:20)

Quiz and immediate discussion of responses

Review of course and wrap up

Quiz

Break (20 minutes)
Session Three (14:40 To 15:40)

Review of course and wrap up

Round table discussion:  
Quiz and discussion of responses
Review of course and wrap

Course Program
Time Topic
Day 1
10:45 to 11:00Registration & Introduction
Day 1-3
11:00 to 13:00Session One
13:00 to 13:20Break (20 minutes)
13:20 to 14:20Session Two
14:20 to 14:40Break (20 minutes)
14:40 to 15:40Session Three