Bill Jordan was a featured panelist during the session, "Mitigating the Risks of Billing Fraud, False Claims Act Violations and Other Abuse and Waste Issues," May 22, 9:00am - 10:15am, at this second annual conference sponsored by American Conference Institute (ACI). The panel presentation addressed the following topics.
- Implementing safeguards to protect against fraud and abuse
- Managing the increasing number of claims brought by whistleblowers
- preparing for government intervention
- Proving to the government arguable mistake versus outright fraud
- Assisting the government in pursuing providers who commit fraud
- Approaching the False Claims Act in a more affirmative way
- Diminishing the loss of trust stemming from a lengthy and drawn-out government investigation
- Ensuring diagnosis codes are properly submitted so that the plan is reimbursed correctly
- Developing a risk adjustment model that withstands government scrutiny
- Assembling a Fraud Investigation Unit to proactively ward off instances of business misconduct
- Reporting to the government and paying back over-payments within a defined time period
- Working with providers to reduce the number of services billed but not rendered
Managed Care Organizations (MCO) are struggling to fight off rampant litigation centered on: antitrust violations, ERISA, medical loss ratios, class actions, False Claims Act violations, and Medicare Advantage. This ACI conference addressed this increasingly complex litigation and where enforcement priorities are headed.
May 22-23, 2012
Loews Philadelphia Hotel / Philadelphia, PA