Technology & Fraud the Connection

We start the New Year off with the #1 MOST IMPORTANT topic in Medicaid today. How to prevent Fraud, Waste and Abuse. Join Richard Yadon as he discusses this topic with experts, Debra Faulkner and David Botsko. (Bio’s Below)

• What is the driving force behind fraud, waste, and abuse?
• What tools and techniques create a winning strategy for combating fraud, waste, and abuse?
• What are the analytic technologies behind fraud prevention?
• How can you transform from a reactive to proactive model?
• What are some creative funding approaches for public and private payers?

Debra L. Faulkner, MBA,MHA

Is a Managing Principal with Verizon Connected Healthcare. Debra has over 25 years in Healthcare payer and government program (Medicare/Medicaid) segments, as well as Hospital and IPA/provider industry segments, and over 10 years Healthcare system and applications. Debra holds a Florida State Insurance 2-15 License, in Health, Life and Annuities. Debra’s Academic background includes a Bachelor of Science Health Administration, St. Leo University and an MBA – Health Administration. Debra has been a strategic healthcare leader with a keen focus on efficient operations, sound fiscal management, new program development and implementing quality initiatives and compliance management. She has extensive experience supporting customer understanding of Medicare/Medicaid fraud, waste and abuse, enrollment, claims and encounter data, outreach strategies and work culture enhancement. She brings a strong knowledge of predictive modeling tools and methodologies, experienced with multiple data analysis/data mining tools and statistical packages. Her deep understanding of healthcare payer, hospital inpatient and outpatient and physician enterprise operations and systems adds to her overall knowledge and skill set.

David Botsko Ph.D, CFE

In June 2012 Dr. Botsko joined Verizon Enterprise Solutions as a Managing Principal. Prior to joining Verizon Dr. Botsko retired in June 2011 after 11 years, as the State of Arizona Medicaid (AHCCCS) Inspector General. The Office of Inspector General is a State of Arizona criminal justice agency. Prior to his service with the State of Arizona David was a federal law enforcement officer for 22 years serving with the U.S. Department of State, Diplomatic Security Service and the U.S. Department of Defense Criminal Investigative Service, retiring in May 1998. He served as a special agent, internal affairs inspector and supervisory special agent. His last assignment was as the Deputy Director for Training assigned to the Inspector General Training Academy located at the Federal Law Enforcement Training Center (FLETC). In this capacity he was responsible for teaching advance courses, supervising staff and developing training curriculum for over 20 different federal agencies. Additionally, he chaired curriculum review committees and monitored future training requirements.

Tags : Medcaid Technology