Past Meetings

Fraud and Abuse Detection Technology

10/20/17  Back

Our October 20 meeting of Health TechNet was be held at the Inova Center for Personalized Health in Fairfax, VA.

The feature topic was the growing use of advanced data analytics and technology tools for detecting and preventing waste fraud and abuse, most importantly before payment is made for medical services.

We had a panel of three speakers to address this topic and lead the discussion: 1) Alee Scott, Special Assistant Attorney General, Medicaid Fraud Control Unit, New York State Office of the Attorney General. 2) Nelson Mullins partner Mike Ruggio, who focuses his practice on healthcare fraud and abuse and civil False Claims Act investigations, healthcare litigation and healthcare regulatory matters with an emphasis on representing hospitals and other healthcare providers, including medical device and pharmaceutical corporations and their respective officers and directors, in matters relating to federal regulation and investigation. Mike previously served as a Senior Counsel at the Department of Justice, and as a Special Assistant U.S. Attorney. 3) Lloyd Brodsky, Lead Solution Architect for Optum, who gave us an overview of the various products and services that are available for predictive analytics, administrative simplification, claims editing, and statistical analysis in the effort to prevent waste, fraud and abuse.

We also had a discussion of the recent Executive Order seeking to facilitate association health plans, led by Deanne Kasim of Santesys Solutions.