Pre-Forum Workshop A
Monday | 23 January 2012
|
Detecting And Preventing Healthcare Insurance Fraud: Controlling Fraudulent Activity And The Related Losses Providers
– Dr. Ibrahim Muhanna, Chairman, Muhanna Foundation, Lebanon |
Registration for each workshop will begin at 08:30. The workshop will commence at 09:00 and end at 14:00 with lunch. There will be breaks at appropriate times.
Rationale
Healthcare insurance fraud is one of the most prevalent fraudulent activities in the world and the GCC is no exception. The misuse and abuse of healthcare insurance mostly involves routine procedures, which is why it goes largely undetected. However this adds to significant losses for both insurance providers and employers who purchase insurance for their employees. The biggest challenge in preventing fraud is detecting the fraudulent behavior since it is easily covered up. This workshop will explore the root cause that supports and encourages fraud and will explore the development of indicators that can provide timely evidence of misuse and enable you to set in place measures of prevention.
Learning Objectives
- Obtaining a tangible measure of the extent of healthcare insurance fraud in your network and the losses
- Using network management and claim management as tools in fraud detection
- Identifying and establishing reliable fraud indicators: Using them to effectively detect misuse and abuse
- Developing a response strategy: What to do when fraudulent activity has been successfully detected
- Making fraud detection and prevention part of your long term growth and development plan
- A collaborative effort: Forming a mutually beneficial partnership with employers and healthcare providers to ensure continued success in fraud prevention