Training Objectives
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.
Register Now Download BrochureInstructor of this course
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
17.5 CPE HOURS
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.
By the end of course, specifically, the attendees will have the knowledge to:
- Identify various types of healthcare/insurance fraud and conduct effective interviews
- Understand various healthcare/insurance fraud penalties & consequences
- Learn how to detect deception in the interviewee during an interview
- Understand how the use of kinesiology aids in interviews
- How to plan for and create the interview setting: where, when, how
- Key techniques for interviewing from the experts
- Recognize what types of approaches to use for various witnesses and subjects
- Recognize and utilize behavioral clues in key interviews
- Synthesize analytic results of the data in the investigation for use in the target interview
- Learn from case studies on the “do’s and don’ts” in interviewing and what brings success
Departments
- SIU/MIAD - Audit and investigations departments
- Data Analytics and business intelligence
- Medical cost containment
- Fraud
- Compliance
- Medical claims
- Reimbursement
- Revenue Cycle Management
- Strategy
- Risk
Level
- Investigators
- Directors
- Managers
- Auditors
- Third Part Administrators
- Certified Information Systems Auditors (CISA)
- Certified Fraud Examiners (CFEs)
- Claims Adjudicators
- Supervisors
- Senior Officers
- Analytics
- Attorneys
- Professionals who want to expand their skillsets in interviewing techniques
- The attendees new to the fraud and abuse world
- Presentations & lectures
- Group discussions
- Exercises & use cases
- Certificate of Achievement
- Course material & handouts
- Study binder
- Lunch with coffee/tea breaks
Course Fee $1800/Participant
Individual
25% Early Bird Discount $1,350 till Oct 13, 2023
15% Early Bird Discount $1,530 till Nov 05, 2023
Groups/Corporate
2+1 Offer $3,600 for 3 Participants
3+2 Offer $5,400 for 5 Participants
Medical Fraud Interviewing Techniques and Behavioral Analytics - Course Schedule
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
- a. The Patient
- Who is the patient? What are some examples of patient fraud?
- b. The Provider
- Who is the provider? What are some examples of provider fraud?
- c. The Payer
- Who is the payer? What are some examples of payer fraud?
- d. The Employer/Plan Sponsor
- Who is the employer/plan sponsor? What are some examples of employer/plan sponsor fraud?
- e. The Vendor and the Supplier
- Who are the vendor and the supplier? What are some examples of vendor and supplier fraud?
- a. The Patient
- Triparte Fraud
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
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
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 in the classroom
- Role Play of natient interviews in the classroom
END OF THE DAY!
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
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
Legal Issues in Healthcare Fraud Investigations, Safeguarding your case within the lawg
- 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
Case Studies and Round Table Discussions
- 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 skillsets to develop in conducting successful forensic interviews
- Emerging Commercial Anti-Fraud Technologies, (Blockchain, AI, Advanced Analytics,
- Q & A
- Presentation of Certificates
- Networking
| Course Program | |
|---|---|
| Time | Topic |
| Day 1 | |
| 07:45 to 08:00 | Registration & Introduction |
| Day 1-2 | |
| 08:00 to 10:00 | Session One |
| 10:00 to 10:15 | Coffee/Tea Break |
| 10:15 to 12:15 | Session Two |
| 12:15 to 13:15 | Lunch Break |
| 13:15 to 14:45 | Session Three |
| 14:45 to 15:00 | Coffee/Tea Break |
| 15:00 to 16:30 | Session Four |