Integrity Advantage was thrilled to participate in the National Health Care Anti-Fraud Association’s Annual Training Conference in Orlando during the week of November 14th. Our team was energized by the event in so many ways! We hosted a booth in the vendor hall for the first time, learned from an incredibly insightful keynote speaker, reconnected face to face with colleagues, and attended a variety of presentations. It was a great honor to also serve as presenters on different topics.

Here’s a recap of our presentations:

Investigative Quality: How to Ensure Your Team Produces High Caliber Work

In the leadership and management track, Jala Attia partnered with Harry Guglielmo from Centene to share insights about how to ensure teams produce high caliber work. Given the challenges that companies faced during the pandemic, including a higher volume of work with less resources, the conversation focused on the importance of assessing investigative quality and building high quality cases - with the ultimate question being: What would your investigative work reveal if it was closely scrutinized?

Many organizations assume that working more cases equals improved results and quality, but churn does not always amount to high quality work product. Quality is everyone’s responsibility and should be measured in day-to-day work through setting measurable and attainable metrics to accurately measure investigative output throughout the lifecycle of a case. One way to measure quality is to perform case file audits at a regular frequency to allow staff to make improvements based on the feedback provided. Also, be sure to tie these to your annual goals so that it becomes an expectation of the team.

Tackling the Large Multi-Specialty Provider Group Investigation

For those with an interest in investigative or analytical skills, Jessica Gay and Michelle Rua Wiedenhofer partnered to talk about multi-specialty group investigations based on a previous case we investigated. Many investigators shy away from investigating these groups for various reasons, so it was important to explain why and how they approached this type of investigation. Oftentimes, the approach for these cases is neither clear nor straight-forward, with many pros and cons. Jess and Michelle walked attendees through the a data mining approach and answered many questions from the audience, which further validated that this type of investigation continues to be a challenge in our industry.

Although our case study resulted in a significant overpayment for our client, the key takeaway was: do not be afraid to investigate these types of cases. Sharing techniques and skills that can help enable a thorough, well-thought out, minimally provider-abrasive investigation could affect positive change for health plans on a larger scale and improve the care members receive.

Our Booth Traffic and Swag

As a vendor, we were excited to exhibit at ATC for the first time as well as share insights and describe our services to attendees. Many visitors grabbed our “Free the SIU” stickers and shared their thoughts on what #FreetheSIU means to them. Our perspective is that the SIU should never live in a small box - regardless of whether they feel they can’t get out of that box or not. The SIU sees so much that happens across the organization and needs to be ‘let out of the box’ and included in more conversations across payer organizations so we can more effectively communicate ways to stem FWA. Our team was grateful to be able to talk about FWA with so many of the good guys, who are fighting fraud alongside us, and to discuss how our team works in collaboration with companies to identify risks, data mine, conduct investigations, review records and provide training, among other services that enhance support for those fighting healthcare FWA!

We hope to be able to connect with you at a conference in 2023 to discuss how Integrity Advantage can help you reimagine the value of your FWA program!

#FreeTheSIU in 2023!

Want a #freetheSIU sticker??

Send us an email at info@integrityadvantage.com with your work address and we’ll send one to you!

ATC Session Takeaways

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