Training Objectives
- Provide quick hits on prevention, detection, investigation, and resolution of FWA.
- Differentiate between auditing and investigating and perform both effectively and efficiently.
- Understand when to pursue allegations and when to close cases.
- Develop strategies for efficiently tackling cases, collecting evidence, conducting interviews, and presenting cases to interested parties.
- Gain access to resources supporting current case trends in reports.
Instructor of this course
MBA, AHFI, CFE, CPC, CFI
Senior Vice President, Medical Investigation & Audit, National Health Insurance Company – Daman
MBA, University of North Dakota
B.Sc., Criminal Justice, North Dakota State University
Accredited Healthcare Fraud Investigator (AHFI), National Health Care Anti-Fraud Association
Certified Professional Coder (CPC), AAPC
Certified Forensic Interviewer, Center for Interviewer Standards and Assessment
6 CPE Hours
- Investigators
- Auditors
- Supervisors and Managers of Auditing/Investigative Units
- SIUs
- Cost Containment Departments
- Presentations/lectures
- Interactive practical exercises
- Individual assignments and interaction
- Group discussions
- Course material
- Certificate of Achievement
The Boot Camp tailored for Health Care Fraud Investigators and Medical Auditors is a comprehensive one-day program designed to equip participants with the necessary skills, toolkit and knowledge to effectively prevent, detect, investigate, and resolve instances of healthcare fraud, waste, and abuse (FWA), and address the evolving challenges in the field.
- In-depth FWA Knowledge
- Strategic Planning Skills
- Proficient FWA Detection
- Practical Prevention Insights
- Enhanced Investigative Skills
- Efficient Report Writing
- Current FWA Trends Awareness
- Proactive Management Tools
Boot Camp for the Health Care Fraud Investigators & Medical Auditors - Course Schedule
Introduction
- Introduction
- Understanding differences between Fraud, Waste, Abuse, and Errors
- Developing an Audit Plan vs. an Investigative Plan
- Triaging allegations to decide pursuit
- Understanding Benefit Packages' impact on investigative strategies
- Detection
- Overview of data analytics, key reports, and metrics
- Thinking creatively to identify FWA through billing rules, reimbursement
- Methodologies and coding
Prevention Strategies
- Investigation
- Collection and tracking of evidence, including chain of custody
- Internet searches and evidence preservation
- Case file maintenance and efficient organization
- Various interviewing techniques for subjects, patients, witnesses, and staff
- Report writing focusing on objectivity, key points identification, and structure
Current Healthcare FWA Schemes and Trends
- Discussion on prevalent schemes and trends
- Identification of tools to support findings.
| Course Program | |
|---|---|
| Time | Topic |
| 08:30 to 09:00 | Registration & Introduction |
| 09:00 to 11:00 | Session One |
| 11:00 to 11:10 | Coffee/Tea Break |
| 11:10 to 12:40 | Session Two |
| 12:40 to 13:30 | Lunch Break |
| 13:30 to 15:00 | Session Three |