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Iowa Regional Health Care Anti-fraud Association

1997 Annual Workshop

August 27 - 28, 1997

Savery Hotel and Spa

401 Locust

Des Moines, IA 50309

 
The Iowa Regional Health Care Anti-fraud Association (I.R.H.C.A.A.) is a non-profit organization of members from law enforcement, professional licensing boards, prosecutors, and health care carriers. The group was established in 1989 to develop an effective network to detect and prevent health care fraud. Educational meetings are held bi-monthly with a two-day workshop held annually. Through the efforts of our group to educate both investigators and prosecutors, health care fraud cases are being successfully prosecuted routinely at both the state and federal levels.
 
Who Should Attend

How You Can Benefit

What You Will Learn

Speakers

Gill Beck JD is an Assistant United States Attorney in Greensboro, North Carolina responsible for civil litigation, with special emphasis on affirmative civil enforcement, health care, and forfeiture involving the United States. He was previously in private practice and has served as a litigation attorney for the U.S. Army. He graduated from Duke University College of Law with high honors and was the Senior Editor of Law and Contemporary Problems. He is the author of The Shareholder's Derivative-Claim Exception to the Attorney-Client Privilege, Law and Contemp. Probs. summer 1985 at 199.
 
Harriet P. Bicksler is the Manager of the Federal Employees Program (FEP) Anti-Fraud Unit. FEP is the largest private health insurance contract in the nation. Harriet began her career with the Federal Employee Program in 1974 as a medical analyst. Her prior experience includes managing the Cost Containment area until the new Anti-Fraud unit was created. Harriette's accomplishments include developing identification, investigation, and reporting systems for FEP. Harriette graduated from Presbyterian Hospital School of Nursing and has worked as a registered nurse.
 
Charles DuVall, DC functioned as a consultant to the Pentagon, FDA, Department of Health and Human Service, Justice Department, International Associations of Special Investigation Units, National Insurance Crime Bureau, the National Health Care Anti-Fraud Association and others. He has developed and implemented training programs to train other physicians and lay investigators in chiropractic and allopathic methods as they apply to medical necessity guidelines. Dr. DuVall is the President of the National Association for Chiropractic Medicine and serves as an independent chiropractic/medical consultant in the USA and Canada. He is certified as an expert witness in 14 states.
 
Richard Glaser, JD is the Chief of the Criminal Division for the United States Attorney's Office in Greensboro, North Carolina. He also serves as the Health Care Fraud Coordinator and Abortion Violence Coordinator. He is responsible for supervision 12 AUSAs; works closely with all federal agents and law enforcement offices, coordinates the grand jury each month, and prosecutes and maintains a normal case load while serving as the lead evaluator of the Department of Justice. In 1996 he received the Department of Justice Director's Award for Superior Performance, the Drug Enforcement Agency's Certificate of Appreciation, and the FBI Labscam Certificate of Appreciation. He has a Masters of Public Policy from Duke University and attended West Virginia University School of Law.
 
Tom Harkin, JD is a United States Senator and is originally from Iowa. He has a long standing interest in health care issues and health care fraud. He graduated from Catholic University Law School and has served on the Agriculture, Nutrition and Forestry Commission, the Appropriations Commission, the Labor and Human Resources Commission, and the Small Business Commission.
 
David Ignatius is a senior consultant for FEP investigations at the Blue Cross and Blue Shield Association in Washington, D.C. David served on the Tustin Police Department in Orange County, California for 9 years and an investigator and sergeant. He also served 7 years as a Major Fraud Investigator for the Orange County District Attorney before becoming a senior investigator for Blue Cross of California. He has a BA in Business Administration from Redlands California University. He has been an advisor on Health Care Fraud for BCBS News, appearing on 48 Hours and Eye to Eye with Connie Chung. He is a member of the Blue Cross Blue Shield National Anti-Fraud Advisory Board.
 
Lynwood Lary, has completed supervisory certification from the California commission of Peace Officer Standards and Training. He serves as an Attorney General Investigator Supervisor for the California Department of Justice, Bureau of Medi-Cal Fraud where he directs a team of investigators performing criminal investigations of provider fraud. He received a Bachelor of Science in accounting from San Diego State University. Mr. Lary is certified as an expert witness and provides training to Department of Health and Human Services auditors and surveyors in the identification and reporting of fraud allegations. He is an Investigator Academy Instructor in Pharmacy case investigations.
 
Ed LeFaivre, Investigator for the Department of Health and Human Services He participated with the US Attorney's Office in the LabCorp of America and other laboratory investigations of billings for unnecessary, unauthorized blood tests. These Federal Labscam investigations identified over 700 million dollars in criminal and civil recoveries.
 
John Renner, MD is a family physician educator and consumer health information advocate. He is founder and president of Consumer Health Information Research Institute and a Clinical Professor of Family Medicine at the University of Missouri School of Medicine. Dr. Renner is an Adjunct Professor of Preventive Medicine at the University of Kansas School of Medicine. Dr. Renner is the editor or author of seven books. He has testified before Congress and several state legislative hearings on health fraud, serves on the board of directors of the National Council Against Health Fraud, Inc. and has been consultant to the FDA.
 
Sgt. Ritch Wagner is a Nebraska State Police Officer Specializing in drug diversion cases. He has 20 years experience in Investigative Services and currently supervises three criminal investigators while carrying a full investigative load. Sgt. Wagner developed the training curriculum on diversion investigations, and teaches advanced narcotics training throughout the United States. A co-author of Department of Health legislation, he also has served as a grant coordinator for Bureau of Justice pharmaceutical drug diversion grants, and is the coordinator for State Patrol involvement in multi-agency federal investigations of health care fraud.
 

Workshop Topics

 
Combating Health Care Fraud, the Unrelenting Battle
In his first-day opening remarks, U.S. Senator Tom Harkin will reveal the findings in the General Accounting Office's audit of health care billing and discuss the efforts his office has undertaken to curb fraud, waste and abuse in of health care spending.
 
LabCorp Laboratory Fraud
On November 21, 1996, the United States Attorneys Offices of seven states and the Criminal Divisions of the Department of Justice announced that Laboratory Corporation America Holdings (LabCorp) agreed to pay $182 million to resolve civil allegations associated with submitting false claims for medically unnecessary lab tests. Attend an "autopsy of a fraud case" and learn how this fraud was discovered, how a national task force was created, how seasoned investigators identified what doctors and witnesses were needed, and how evidence was handled during the two year investigation. Topics will include what steps the investigation, prosecution and civil team took as we dissect the case. But bringing offenders to isn't all that's needed. This case will restore millions of dollars to federal and state health care programs, and provides an antidote for loss through the use of parallel proceedings.
 
Fraudulent Cancer Treatment Billings
The claim may say that the patient received inpatient chemotherapy treatments. But in reality, the "patient" stays in a hotel, takes a bus into a clinic in another country for unproven therapies, and a billing service collects the health care payment in a post office box. Find out how unscrupulous providers may disguise non-payable experimental or quack cancer treatments rendered in an office as inpatient chemotherapy. Learn who they are and how to detect chelation therapy, how fear is used to swindle the public, the growth of health frauds and unproven therapies, and how one dedicated professional teaches patients and the public on how to discern health fraud and abuse.
 
Health Care Fraud Trends
In the fast pace of medical technology, medicine and methods to improve health are the only areas changing. Health care fraud trends change constantly in every facet of the health care spectrum. Learn from a dedicated professional what the latest "scams" are in the industry, how to detect them and how to analyze, implement, and monitor corrective action.
 
Chiropractic Billing Fraud
This session will feature an overview of chiropractic billing and will spotlight potential problem areas, including diagnosis changing and pediatric billings on chiropractic services claims. Follow the presenter through undercover investigations which were televised by 60 Minutes. With the new CPT '97 codes that have been released there are five new codes. Learn how to zero in and detect problems associated with health care fraud and over-utilization of chiropractic treatments.
 
Prescription for Health Care Fraud
A panel of "professionals" will present how they illegally obtained prescription drugs and how they were caught. Learn from a twenty -year law enforcement veteran how to investigate cases of pharmacy diversion fraud. But the cost isn't just the prescriptions, it is the medical bills as well. So even programs which do not cover prescription items may be vulnerable to pharmacy fraud. Learn from the special team entrusted with Federal Employees Benefits how they successfully tracked and packaged drug diversion cases of health care fraud.
 
Testing for Kickbacks
In a clever sting operation, one agency set up an undercover medical clinic and found out that who came calling were providers offering kickbacks for the referral of Medicaid patients. Solicitations were video and audio taped as evidence. Learn from the supervising investigator how to catch a thief. In this session you will learn how the team created the undercover operation, how Labtest was organized, and how the undercover investigation resulted in the arrest and convictions of suspects offering the kickbacks.
 
Nursing Continuing Education Credits
 
This workshop is for RNs and LPNs employed in the health insurance industry, medical offices.
 
The objective of this workshop is to:
Increase your awareness of the many forms of fraud in the medical field,
Increase knowledge of investigative techniques
Increase knowledge of prosecution methods
Describe parallel litigation
Explain laboratory billing fraud
Describe cancer treatment billing fraud
Point out emerging health care fraud trends, and
Describe chiropractic billing fraud schemes.
 
This course has been approved for 1.25 CEUs under Provider # 22. The registration fee includes the $5.00 processing charge. Call Teresa Clark at 237-6582 for questions.
 
Legal Continuing Education Credits
 
Sessions may qualify for credit for continuing legal education. An application is being made and approval is pending.
 
Certified Fraud Examiners Continuing Education Credits
 
The course qualifies for continuing education credit for Certified Fraud Examiners.
 
Hotel Information
 
Savery Hotel and Spa
401 Locust Street
Des Moines, IA 50309
515-244-2151
 
The Savery Hotel and Spa is conveniently located in the center of Des Moines Downtown Development with easy access to Intestate 235. There is a free airport shuttle and it is minutes away from shopping malls, movie theaters, local attractions, and restaurants.
 
A block of special guest rooms has been reserved for this workshop at the special rate of $69.00 single, $75.00 double. To reserve a room, you may call 1-800-798-2151 for room reservations and indicate that you are registering for the IRHCAA annual fraud workshop to receive this special rate.
 
Conference dress code is business casual
 
 

Schedule

 
Wednesday 8/27/97
 
8:00 Registration
 
8:30 - 9:00 Combating Health Care Fraud, A Senator's Perspective
United States Senator Tom Harkin (requested)
 
9:00-11:30 Chiropractic Billing Fraud
Charles S. DuVall, D.C.
 
11:30-1:00 lunch served at hotel (included in registration)
 
1:00- 2:00 Health Care Fraud Trends
Charles S. DuVall, D.C.
 
2:00-2:15 break
2:15- 4:30 Pharmacy and Medical Fraud/Pharmacy Diversion Cases
Dave Ignatius and Harriet Bicksler
Sgt. Ritch Wagner and offender Panel
4:30-7:00 Hospitality Suite
 
Thursday 8/28/97
 
8:00 Continental breakfast
 
8:30-9:30 Fraudulent Cancer Treatment Billing
John Renner, MD
 
9:30-11:45 Testing for Thieves - Labtest Undercover Sting Operation
Lynwood Lary
 
11:45-1:00 Lunch
 
1:00:-4:30 Investigating the LabCorp of America health care fraud
Ed LeFaivre
Criminal Prosecution of Laboratory Billing Fraud From Investigation Report to Jury Verdict
Richard Glasser, JD
Successful Civil Remedies Using Parallel Proceedings in Laboratory Billing Fraud
Gill Beck, JD
 
4:30 - 4:45 Wrap Up, Closing Remarks
Evaluations, Hand out continuing education certificates.
 

 

Registration Form

 
The cost of the workshop is $50.00 per person. Partial day discounts are not available.
Complete the following form and return to:
 
I.R.H.C.A.A
Station 50
636 Grand Ave
Des Moines, IA 50309
(515) 245-4779
 
 
Name: _____________________________________________________
 
Title: ______________________________________________________
 
Firm/Agency ________________________________________________
 
Address: ___________________________________________________
 
___________________________________________________
 
___________________________________________________
 
 
Phone: ________________________________________
 
E-mail: ________________________________________
 
Social Security # _____ ____ _________________
(for Continuing Education Credit where applicable)
 
Please enclose the registration fee of $50.00 per person.
 
Refund Policy: Full refunds will be given for cancellations received prior to August 18, 1997.

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