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Dorland Webinar Slide Managed Care

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Webinar presentation in August 2010

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Fraud and Abuse A Managed Care Perspective By Susan Kohler
Agenda ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laws Regulating Managed Care (Medicare/Medicaid) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laws Regulating Managed Care (Medicare/Medicaid) ,[object Object],[object Object],[object Object]
Laws Regulating Managed Care (Medicare/Medicaid) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laws Regulating Managed Care (Medicare/Medicaid) ,[object Object],[object Object],[object Object],[object Object],[object Object]
New Laws ,[object Object],[object Object],[object Object],[object Object],[object Object]
Overpayments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Enforcement ,[object Object],[object Object],[object Object],[object Object]
Role of Managed Care Organizations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Defining Abuse ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Examples of Abuse ,[object Object],[object Object],[object Object],[object Object],[object Object]
Defining Fraud ,[object Object]
Examples of Fraud ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Abuse vs. Fraud – Understanding the Difference ,[object Object],[object Object],[object Object],[object Object]
Identification and Investigation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Medicaid and Medicare providers have an obligation to cooperate
Medical Record Review ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Notification to Provider ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Provider Responsibilities ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary ,[object Object],[object Object],[object Object],[object Object]
Questions?

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Dorland Webinar Slide Managed Care

  • 1. Fraud and Abuse A Managed Care Perspective By Susan Kohler
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