Join us for this informative session developed specially for antifraud professionals.
Featured Gartner research director, Joanne Galimi, discusses the key components of a robust antifraud program, steps to follow in designing and implementing a program as well as critical steps to a successful implementation.
Steven Skwara, Director of Investigation and Prevention at Blue Cross Blue Shield of Massachusetts, shares his real world expertise in a discussion of how best to integrate automated antifraud solutions into workflow for optimum results, including:
- Structure of a special investigative unit
- Lead identification
- Changes in the day-to-day operating processes
- Lessons learned
- And more
Speaker: Joanne Galimi, Research Director, Gartner
Joanne Galimi is a Research Director in Gartner's Research organization.
Prior to joining Gartner, Ms. Galimi was part of the strategic planning team at Harvard Vanguard Medical Associates in Boston. She has extensive healthcare experience, with primary focus in the managed care market in areas of customer relationship management, business intelligence, fraud and abuse, healthcare payer IT budget and staffing, and business process management.
"This position allows me the opportunity to be in the healthcare industry researching numerous topics of interest. I like that this industry keeps me challenged with new and exciting areas to focus on. In addition, interacting with healthcare players provides me the opportunity to learn and stay up to date with the market."
Speaker: Steven Skwara, Associate General Counsel, Blue Cross Blue Shield of Massachusetts
Mr. Skwara is the Director of Blue Cross Blue Shield of Massachusetts' Fraud Investigation and Prevention ("FIP") Unit. He is also Associate General Counsel for the company. In these capacities, Mr. Skwara supervises the investigation of suspected fraud and abuse by BCBSMA providers and members and litigates, or supervises the litigation of, fraud and abuse-related cases against providers and members. Mr. Skwara and BCBSMA's FIP Unit also work closely with federal and state investigative agencies in cases involving potentially criminal conduct.
In the past three years, BCBSMA's FIP Unit has recovered nearly $17 Million in fraudulent, or potentially fraudulent, claims from health care providers and others involved in the health care delivery system. The FIP Unit has also assisted in the successful criminal prosecutions of approximately ten to twelve providers during that time. In May 2005, BCBSMA's FIP Unit won the first ever "BlueWorks" anti-fraud award from the Blue Cross and Blue Shield Assocation for an innovative anti-fraud program that resulted in a $2.3 Million recovery to BCBSMA.
Mr. Skwara graduated from Yale University and the University of Michigan Law School. Mr. Skwara was previously associated with Goodwin Procter where his practice focused on health care fraud and abuse defense and securities-related litigation. In 1995 and 1996, Mr. Skwara served as a Special District Attorney in Middlesex County, Massachusetts.
Mr. Skwara serves on the Executive Committee of the National Health Care Anti-Fraud Association ("NHCAA") and is currently Treasurer of that association. He has spoken on health care fraud topics at seminars and conferences presented by the NHCAA, the American Bar Association, and the Blue Cross and Blue Shield Association.
Moderator: Brian Zonis, Antifraud Solutions Specialist, ViPS, an Emdeon company
Brian Zonis is an Information Systems professional with 10 years of healthcare technology experience built upon technical knowledge, business understanding and inter-personal communication skills. Brian works closely with ViPS' antifraud clients to ensure business and analytical requirements are met.
Brian's expertise includes data mapping, extract development, loading, user and technical training, software quality testing, product enhancement planning and customer support. He possesses the unique combination of understanding customers' technical needs and the business analytical needs to ensure proper return on investment.
Prior to joining ViPS, Brian was a Systems Analyst for McKessonHBOC leading implementation activities such as training and support for their Clinical Decision Support System.
Brian received a Computer Science degree from Shippensburg University in Pennsylvania in 1994.
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