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Fraud Waste and Abuse and SIU Peer Group Call: October 2023

Event Date: 10/10/2023

Event Overview

Tuesday, 10/10/2023
1:00 PM CT – 2:00 PM CT (60 minutes)
Hosted by: Health Plan Alliance

Fraud Waste and Abuse (FWA) and SIU managers convene to share challenges and best practices. Join us to learn how Alliance member health plans engage in sound processes and structures and innovative solutions for managing fraud, waste, and abuse. Hear how organizations leverage their SIUs or are approaching creating one.

 

PLATFORM NOTES: The roundtable discussion will be hosted on Zoom.

Audience

Stakeholders responsible for fraud, waste, and abuse detection and prevention, and those involved in SIUs at their plan. Those responsible for payment integrity, financial management, compliance, and legal aspects of FWA along with team members in government programs are also invited to join the call.

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Documents
10/10/2023

Recording: Fraud Waste and Abuse and SIU Peer Group Roundtable
Fraud Waste and Abuse (FWA) and SIU managers convene to share challenges and best practices. Topics include broker fraud, CMS Quarterly FWA reports, CMS PI audits, paying recovery dollars to vendor partners, and the need to for case study sharing.

Attendees

Below is a list of all delegates registered to date for this event

  • Brit Ben-Zikri
  • ALLIANCE MEMBER
  • SIU Supervisor at Quartz Health Solutions
  • Kristin Calkins
  • ALLIANCE MEMBER
  • SIU Investigator at Quartz Health Solutions
  • Lisa Carlson
  • ALLIANCE MEMBER
  • Vice President, Product Strategy & Development at Avera Health Plans
  • Nadine Casey
  • ALLIANCE MEMBER
  • Compliance Consultant - Fraud, Waste and Abuse Program at IU Health Plans
  • Marty Cerier
  • ALLIANCE MEMBER
  • Director Regulatory Audits and Investigations at Health Alliance Plan (HAP)
  • Karla Colasacco
  • ALLIANCE MEMBER
  • CPhT at FirstCarolinaCare Insurance Company
  • Kathy Coslett
  • ALLIANCE MEMBER
  • SIU Manager at Geisinger Health Plan
  • Lisa Denney
  • ALLIANCE MEMBER
  • FWA Supervisor at Johns Hopkins Health Plans
  • Juanita Dowell
  • ALLIANCE MEMBER
  • Compliance Program Manager at Care N' Care Insurance Company, Inc.
  • Kathleen Durham
  • ALLIANCE MEMBER
  • Senior SIU Investigator at Paramount Health Care
  • Bianca Faugno
  • ALLIANCE MEMBER
  • Pharmacy Technician at Cox HealthPlans
  • Maira Fraire
  • ALLIANCE MEMBER
  • Quality Assurance at Alliant Health Plans
  • Stefani Geter
  • ALLIANCE MEMBER
  • AVP, Compliance and Privacy at Ochsner Health Plan
  • Willam Gilmer
  • ALLIANCE MEMBER
  • Fraud, Waste, and Abuse Investigator at Parkland Community Health Plan
  • Mary Glasgow
  • ALLIANCE MEMBER
  • Senior Corporate Compliance Auditor at Physicians Health Plan
  • Denise Grussing
  • ALLIANCE MEMBER
  • Special Investigations Analyst at Health Alliance Medical Plans
  • Kaitlyn Hammond
  • ALLIANCE MEMBER
  • Director of Government Programs at Cox HealthPlans
  • Megan Holly
  • ALLIANCE MEMBER
  • Government Programs Coordinator at Cox HealthPlans
  • Shawn Inman
  • ALLIANCE MEMBER
  • Medical Reviewer Nurse at CommunityCare
  • Karen Jensen
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment and SIU at Quartz Health Solutions
  • Candace Johnson
  • ALLIANCE MEMBER
  • SIU Investigator at Quartz Health Solutions
  • Rita Johnson
  • ALLIANCE MEMBER
  • Coding Compliance Specialist / Educator at Presbyterian Health Plan
  • Lisa Line
  • ALLIANCE MEMBER
  • SIU Investigator at Paramount Health Care
  • Fran McMaster
  • ALLIANCE MEMBER
  • Compliance Consultant at Piedmont Community Health Plan
  • Mary McMaster
  • ALLIANCE MEMBER
  • Lead Investigator at CommunityCare
  • Garland Morton
  • ALLIANCE MEMBER
  • Director of Compliance and Privacy at Piedmont Community Health Plan
  • Daniel O'Connell
  • ALLIANCE MEMBER
  • Vice President of Health Services at Cox HealthPlans
  • Carol Pawlosky
  • ALLIANCE MEMBER
  • RN, BSN, SIU Program Manager at MediGold
  • Leslie Pels-Beck
  • ALLIANCE MEMBER
  • Chief Operations Officer at Sharp Health Plan
  • Teresa Powers
  • ALLIANCE MEMBER
  • SIU Analyst - Special Investigations Coordinator at Samaritan Health Plans
  • Cindy Ramos
  • ALLIANCE MEMBER
  • Health Care Investigator at MetroPlusHealth
  • Noreen Rhoades
  • ALLIANCE MEMBER
  • Program Integrity Manager at Community Health Plan of Washington
  • Melissa Rusk
  • ALLIANCE MEMBER
  • Vice President Operations at SummaCare
  • Caryn Smith
  • ALLIANCE MEMBER
  • Director of Risk Adjustment at HealthTeam Advantage
  • Arya Steinhauer
  • ALLIANCE MEMBER
  • Director of Internal Audit at Quartz Health Solutions
  • Deb Sterner
  • ALLIANCE MEMBER
  • Clinical Auditor at Geisinger Health Plan
  • Sing Tam Lee
  • ALLIANCE MEMBER
  • External Audit Investigator at Providence Health Plan
  • Brittany Tuggle
  • ALLIANCE MEMBER
  • Clinical Nurse Investigator at Health First Health Plans
  • John Waugh
  • ALLIANCE MEMBER
  • Director - SIU at Johns Hopkins Health Plans
  • Erin Woods
  • ALLIANCE MEMBER
  • SIU Clinical Auditor at Health Alliance Medical Plans
  • Carol Znaniecki
  • ALLIANCE MEMBER
  • Corporate Compliance & SIU Data Analyst at Health Alliance Medical Plans