Latest Trends in Pharmacy Fraud, Waste and Abuse Audits
Wednesday, 11:00 a.m. - 12:00 pm.
Level II
Jessica Schmor, RN, AHFI, CPC, CCS
Executive Director, Amenity Consulting
Mike Debelle, MBA
Senior Manager, Optimity Advisors
Faculty will review the latest pharmacy Fraud, Waste, and Abuse trends, identification practices, and algorithm build. Participants will learn how to construct a robust Fraud, Waste, and Abuse audit program that does not simply focus on pharmacy claims, but includes often overlooked categories such as DME and the intersection of pharmacy and medical claims, and how to build an effective audit team across all audit disciplines. Throughout the session faculty will use case studies to support and reinforce the topics being presented.
Compounded Injectible Drugs
Wednesday, 1:30 p.m. - 2:30 p.m. | Thursday, 10:15 a.m. - 11:15 a.m.
Level III
Ayms Lang, MD, CPC, AHFI, CFE
Senior Investigator, WellPoint, Inc.
The presenter will identify emerging trends and schemes regarding compounded injectible drugs, specifically, testosterone pellets and hyaluronic acid. The discussion will cover topics of "drug piracy" and regulations unique to hyaluronic acid, which the FDA has classified as a device rather than a drug. These cases have escalated into a multi-state, multi-agency investigation.
Pharmaceutical Wholesalers and Part D Fraud
Thursday, 8:15 a.m. - 9:30 a.m. | Friday, 9:45 a.m. - 11:00 a.m.
Level II
Stephen Mahmood
Special Agent, U.S. Department of Health & Human Services, OIG-OI
Daniel Crespi
Special Agent, U.S. Department of Health & Human Services, OIG-OI
Houston E. Ramsey, Jr.
Special Agent, U.S. Food & Drug Administration, OCI
Donald W. DeGroff
Senior Principal, IMS Government Solutions
The panel will present a case study focused on a pharmaceutical wholesaler located in Miami-Dade County, FL. The wholesaler provided fraudulent drug pedigrees and invoices to Medicare Part D providers in the South Florida area. These providers were submitting false claims to Medicare Part D plan sponsors and the fraudulent invoices/pedigrees were used to support the false claims. The topics to be covered include referrals to the OIG, Part D fraud and the need for fake invoices, FDA nexus and drug pedigrees, NBI-MEDIC coordination with PBMs, invoice analysis and invoice review, criminal prosecution and spinoff investigations.
Investigation Techniques for Part D Cases
Thursday, 11:30 a.m. - 12:30 p.m.
Level II
Robert Breeden
Special Agent, U.S. Department of Health & Human Services, OIG-OI
Heather Tucci
Special Agent, U.S. Department of Health & Human Services, OIG-OI
The workshop will include how undercover operations can assist in the effective investigation and prosecution of physicians and civilians involved in the criminal distribution of narcotics. Faculty will demonstrate how this distribution results in the fraudulent use of the Part D program. The presentation will highlight those areas to focus an investigation and lessons learned from prior investigations, examining the overlap that exists between healthcare fraud in the Part D and Part B programs, and how to use that overlap to enhance your investigation.
Wednesday, 11:00 a.m. - 12:00 pm.
Level II
Jessica Schmor, RN, AHFI, CPC, CCS
Executive Director, Amenity Consulting
Mike Debelle, MBA
Senior Manager, Optimity Advisors
Faculty will review the latest pharmacy Fraud, Waste, and Abuse trends, identification practices, and algorithm build. Participants will learn how to construct a robust Fraud, Waste, and Abuse audit program that does not simply focus on pharmacy claims, but includes often overlooked categories such as DME and the intersection of pharmacy and medical claims, and how to build an effective audit team across all audit disciplines. Throughout the session faculty will use case studies to support and reinforce the topics being presented.
Compounded Injectible Drugs
Wednesday, 1:30 p.m. - 2:30 p.m. | Thursday, 10:15 a.m. - 11:15 a.m.
Level III
Ayms Lang, MD, CPC, AHFI, CFE
Senior Investigator, WellPoint, Inc.
The presenter will identify emerging trends and schemes regarding compounded injectible drugs, specifically, testosterone pellets and hyaluronic acid. The discussion will cover topics of "drug piracy" and regulations unique to hyaluronic acid, which the FDA has classified as a device rather than a drug. These cases have escalated into a multi-state, multi-agency investigation.
Pharmaceutical Wholesalers and Part D Fraud
Thursday, 8:15 a.m. - 9:30 a.m. | Friday, 9:45 a.m. - 11:00 a.m.
Level II
Stephen Mahmood
Special Agent, U.S. Department of Health & Human Services, OIG-OI
Daniel Crespi
Special Agent, U.S. Department of Health & Human Services, OIG-OI
Houston E. Ramsey, Jr.
Special Agent, U.S. Food & Drug Administration, OCI
Donald W. DeGroff
Senior Principal, IMS Government Solutions
The panel will present a case study focused on a pharmaceutical wholesaler located in Miami-Dade County, FL. The wholesaler provided fraudulent drug pedigrees and invoices to Medicare Part D providers in the South Florida area. These providers were submitting false claims to Medicare Part D plan sponsors and the fraudulent invoices/pedigrees were used to support the false claims. The topics to be covered include referrals to the OIG, Part D fraud and the need for fake invoices, FDA nexus and drug pedigrees, NBI-MEDIC coordination with PBMs, invoice analysis and invoice review, criminal prosecution and spinoff investigations.
Investigation Techniques for Part D Cases
Thursday, 11:30 a.m. - 12:30 p.m.
Level II
Robert Breeden
Special Agent, U.S. Department of Health & Human Services, OIG-OI
Heather Tucci
Special Agent, U.S. Department of Health & Human Services, OIG-OI
The workshop will include how undercover operations can assist in the effective investigation and prosecution of physicians and civilians involved in the criminal distribution of narcotics. Faculty will demonstrate how this distribution results in the fraudulent use of the Part D program. The presentation will highlight those areas to focus an investigation and lessons learned from prior investigations, examining the overlap that exists between healthcare fraud in the Part D and Part B programs, and how to use that overlap to enhance your investigation.
No comments:
Post a Comment