Aug. 27, 2019 | 12pm - 1pm ET
Hosted by Health Data Management
Fraudulent charges and practices know no boundaries, and no organization is immune from being victimized. Even law-abiding healthcare organizations can find themselves as victims of fraud, and those losses will become increasingly painful in the era of value-based care. To defend themselves, organizations can adopt analytics best practices to detect fraud, waste and abuse.
That’s what SCAN Health Plan used recently to identify predatory pharmacies that were fraudulently distributing unordered medications and billing for them at inflated prices. How did it work? The special investigations unit of SCAN, a not-for-profit Medicare Advantage health plan participating in Southern California for Seniors, used analytics to identify pharmacies that fraudulently dispensed medications to seniors who didn’t need them. They analyzed claims data to identify these pharmacies and cut off payments to them, contributing to cost avoidance of more than $1.5 million in the first year of the program.
This webinar will tell the details of how SCAN’s investigation unit shut the door on this fraud. Attendees will learn:
Manager, Special Investigations
SCAN Health Plan
SCAN Health Plan
Senior Director, Healthcare Solutions Strategy and Marketing
Editor in Chief
Health Data Management
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|CE Credit is being offered for this webinar.
This program has been approved for up to 1 continuing education (CE) hours for use in fulfilling the continuing education requirements of the Certified Professional in Healthcare Information and Management Systems (CPHIMS) and Certified Associate in Healthcare Information and Management Systems (CAHIMS).