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Preparing for Audits & Investigations (NYSADSA)
May 25 @ 9:00 am - 10:00 amFree
What to Expect During An Audit (Process)
- Who audits – What agencies/healthplans?
- Why they audit
- Documentation they request & why
- What you should and shouldn’t do
- What they are reviewing
- Outcomes of an audit & why its important to be prepared
How to prepare (Proactive vs Reactive)
- Risk Assessments
- Compliance Plan
- Internal audits
- Monthly monitoring
- Case Studies from former OIG agent
Director, Litigation, FWA @ Advize Health
Education, Outreach and Training Subject Matter ExpertSeasoned federal law enforcement officer (25 years), specializing in white-collar crime investigations. Wide-ranging experience involving federal healthcare programs, with an emphasis on crimes involving the Medicare and Medicaid programs by health care providers, including physicians, pharmacies, and health care entities. Demonstrated success in complex criminal investigative management and planning. Over $500 million in restitution, forfeiture, damages, penalties, and fines to government programs and over 150 convictions and civil settlements involving healthcare fraud matters. Broad trial experience, including three criminal trials in fourteen months. 20 years of presentation and training facilitation experience and a feature presenter/trainer at local, regional, and national training academies, conferences (such as the National Healthcare Fraud Association), and subject matter case analysis. Extensive mentoring and training of new agents. A conduit of information on internal and external policies and procedures for criminal, civil, and administrative investigative matters. Obtained Certified Fraud Examiner Certification September 2019.
Extensive experience providing training to private health care fraud investigators as well as investigators and agents within HHS. A regular presenter at the National Health Care Fraud Association, the premier health care fraud advocacy group. Presented on such topics as podiatry fraud, kickbacks, and investigative planning. Instructor at the HHS-OIG Special Agent Basic Training Academy, providing instruction on health care fraud basic concepts, data mining for health care fraud, case management, and trial preparation.