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Co-authors of Building Management in Healthcare by the Numbers (2008),Rezai and Jansen will lead a roundtable discussion about tying compliance,claims, analytics, audit, legal and investigations together to create a moreeffective plan to deter, detect and prevent fraud. The National HealthcareAnti-Fraud Association has noted that in the U.S. alone, it has been estimatedthat nearly 68 billion dollars have been lost to healthcare fraud. "Withhealthcare spending going up, these numbers will escalate, too," said Rezai."Our discussion will focus on some of the proactive steps health payers cantake to stem these losses, including how to determine whether to outsource thefraud management function or maintain it internally." Rezai is chiefcompliance officer at Adaptis and has nearly a decade of healthcare complianceexperience.
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"Healthcare fraud bears little resemblance to the typical criminal act,where it is frequently known what was committed, where and when. Withhealthcare fraud, there is often only the suggestion that a provider isperforming differently than peers. Identifying healthcare fraud, especiallywhen plans are already working hard to meet challenging regulations, demands aspecialized approach," said Dr. Jansen, a healthcare compliance veteran ofmore than 30 years, the last 20 focusing on healthcare fraud detection andprevention.
About Practice Management Alternatives, LLC
PMA provides fraud prevention, audit and compliance services to healthplans, fraud and abuse lawyers, community health centers, community mentalhealth centers, regional hospital groups and individual practitioners.Principals are certified fraud examiners (CFE), certified forensic consultants(CFC) by the American College of Forensic Examiners and are certified inhealthcare compliance (CHC).
About Adaptis
Adaptis is a BPO company committed exclusively to healthcare. Adaptisfrees healthcare payers from claims and process logistics so they can focus ontaking care of members. Headquartered in Seattle, Adaptis has a regionaloperations center in Yakima, Wash. and a majority-owned subsidiary, TelaSourcing Inc., an ISO 9001:2000 certified international facility in Pune,India. For more information, visit adaptis.com.
SOURCE Adaptis
