Healthcare Fraud and the Special Investigations Unit

Adaptis Sponsors AHIP 2008 Medicare/Medicaid Conference Presentation

September 12, 2008

Seattle, WA – Adaptis, a business process outsourcing company focused on the health payer market, is sponsoring a breakfast symposium at the AHIP 2008 Medicare/Medicaid Conference in Washington, D.C. on Monday, Sept. 22. The session, Special Investigations Units in Health Plans will be facilitated by Roya Rezai, CHC, of Adaptis and Derek Jansen, PhD, MPH, a principal in Practice Management Alternatives, LLC.

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 more effective plan to deter, detect and prevent fraud. The National Healthcare Anti-Fraud Association has noted that in the U.S. alone, it has been estimated that nearly 68 billion dollars have been lost to healthcare fraud. “With healthcare spending going up, these numbers will escalate, too,” said Rezai. “Our discussion will focus on some of the proactive steps health payers can take to stem these losses, including how to determine whether to outsource the fraud management function or maintain it internally.” Rezai is chief compliance officer at Adaptis and has nearly a decade of healthcare compliance experience.

“Healthcare fraud bears little resemblance to the typical criminal act, where it is frequently known what was committed, where and when. With healthcare fraud, there is often only the suggestion that a provider is performing differently than peers. Identifying healthcare fraud, especially when plans are already working hard to meet challenging regulations, demands a specialized approach,” said Dr. Jansen, a healthcare compliance veteran of more than 30 years, the last 20 focusing on healthcare fraud detection and prevention