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