Conference to combat health care fraud

With estimates of annual losses as much as $230 billion and legitimate costs also skyrocketing, the US health care industry is now looking to better control the impact of fraud. And with the ever-growing amount of data involving health care claims, new automated fraud-fighting capabilities are absolutely required.

“Health care fraud represents a major target for cost control as we examine how to increase the efficiency of our system”

An expert panel discussion at the SAS Health Care & Life Sciences Executive Conference, April 21-22 in Cary, NC, will present innovative methods to combat fraud. Participants will include Louis Saccoccio, Executive Director of the National Health Care Anti-Fraud Association (NHCAA); Julie Malida, SAS Principal for Health Care Fraud; and Jay King, SAS Advanced Analytics Lab Development Manager.

SAS Market Research Manager Jonathan Whaling will also present findings from a focus group with anti-fraud practitioners at the NHCAA Annual Training Conference. Results include fraud strategies of major health plans and how they plan to improve. The focus group also discussed fraud versus abuse, the evolution of fraud, recovery and prosecution.

"Health care fraud represents a major target for cost control as we examine how to increase the efficiency of our system," said Saccoccio. "Aggressive efforts to rein in fraud with advanced technology that's available today can provide significant monetary results."

SAS, the leader in business analytics, previously unveiled the SAS^® Fraud Framework for Health Care, a solution that reviews hospital, medical and pharmacy claims to prevent fraud, waste and abusive claims with the ultimate goal of reducing health care costs. Using business rules that uncover billing violations and advanced analytics to identify anomalies, predictors of fraud, and collusion, the SAS solution produces results that help fraud investigators to be more efficient and effective.

"Through the power of SAS Business Analytics solutions, the fraud framework allows investigators to avoid reliance on the pay-and-chase syndrome, which catches less than 10 percent of health care fraud," said Malida, a 26-year industry veteran who led a health care fraud investigative firm before joining SAS.

"The health care industry has to be much more proactive and stop fraud before it is paid. We can show how technology is a key asset in turning this situation around," said Malida.

In addition to the fraud panel, the event will include numerous notable speakers, and other sessions will address a variety of topics with health care and life sciences. Session topics presented by customers will include such issues as financial management, clinical trials optimization and others.

Conference speakers include:

• Mike Huckabee, former Arkansas governor, former presidential candidate, Fox News commentator and author of books advocating personal health improvement.
• Elder Granger, MD, retired US Army Major General, who managed health care delivery for 10 million military members.
• Phillip Johnson, Founder and President, Philip W. Johnston Associates.
• Rear Admiral Theresa Cullen, MD, MS, Chief Information Officer (CIO) and Director, Office of Information Technology, Indian Health Service, US Department of Health and Human Services.
• John D. Halamka, MD, MS, Chief Information Officer, Harvard Medical School and Beth Israel Deaconess Medical Center.
• Aarti Shah, PhD, Vice President, Global Statistical Sciences and Advanced Analytics, Eli Lilly and Company.

Source SAS