On-Demand Web Seminar  Winning with analytics: Fighting fraud perpetrated by predatory pharmacies

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 on-demand webinar will tell the details of how SCAN’s investigation unit shut the door on this fraud. Attendees will learn:

  • How to capture, blend and prep data from disparate data sources.
  • How to analyze claims and prescription data to proactively identify fraud, waste and abuse.
  • How to schedule analytic workflows to run automatically.
  • How to use analytics to collaborate and build partnerships throughout an organization.

Featured Presenters:

Katherine Yue
Manager, Special Investigations
SCAN Health Plan
Cassandra Olsen
Risk Analyst
SCAN Health Plan
Andy Dé
Senior Director, Healthcare Solutions Strategy and Marketing
Fred Bazzoli
Editor in Chief
Health Data Management

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