Finding Provider Fraud

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Thursday, October 27, 2011 2:14:00 PM Categories: Prior Presentations


Fraud prevention starts with fraud detection. This webinar features two innovators in fraud detection. 

Rich Lanza is a nationally recognized Certified Fraud Examiner who has developed principles and procedures related to fraud detection for a wide range of business financial transactions.  He has worked with Health Decisions on a number of self-funded plan reviews. We are proud to have him share his expertise with attendees.

Michael Falis is Health Decisions’ Lead Software Developer. He has applied Rich’s principles to the analysis of health claim payments. He will share this important advance in provider fraud detection. 

Unlike traditional health fraud investigations that second guess providers’ clinical judgments with a “guilty until proven innocent” approach, the use of financial analyses focuses on the few providers with atypical billing and payment patterns that are the early indicators of possible fraud.

To download the slides from the presentation click here

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