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Wednesday, March 20 • 10:00am - 11:00am
Track 4: INDUSTRY SESSION -Incorporating Non-Traditional Data into Your Workflow Will Expand Your Decision Making Processes

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Fraud, Waste and Abuse (FWA) is an ever- growing problem in the Medicaid program and all HHS programs. Driven by bad actors, every dollar lost due to fraud, waste and abuse is a dollar that won’t be spent helping someone who needs assistance. That is just the start; the downstream impacts from Medicaid abuse is almost incomprehensible and immeasurable. Unfortunately, the bad actors are finding ways to avoid detection and those on the program front lines are limited to their view that only their data can provide them. The only way to truly combat these threats against our public healthcare system is to have the most comprehensive, collaborative view of those participating in your programs: members and providers.

The first step in the battle lies right at the beginning of the relationship established between an individual member and provider with the State and its programs. All states undergo a very important eligibility determination and screening processes, but are they enough? Eligibility screening verifies if the person applying actually qualifies for program benefits with the assumption that the determination is the correct person. However, is the person really who they say they are? Similarly, with providers; checking a few databases is a good start, but do you have a full picture of all the risks the provider can expose to your program? The answer to both questions will never result with 100% yes; however, accessing more data and filling in missing pieces will certainly give you a better edge. 

The presenter will discuss how state agencies can detect and, more importantly, prevent threats to your program on multiple fronts by applying the best data in the right part of your workflow. He will also share national best practices as well as the future of data and data sharing. He will provide demonstrations of both solutions. Attendees will learn how to:

  • Access the most effective non-traditional data to help strengthen your program.
  • Save time and increase productivity by reducing the amount of transactions being scrutinized during screening processes.
  • Prevent threats by flagging stolen or synthetic identities and surfacing provider risks.
  • Leverage shared intelligence to combine provider and identity data with agency data for expanded network visibility across claims, provider, individual, business and non-healthcare fraud data.

avatar for Justin Hyde, Sr.

Justin Hyde, Sr.

Director of Market Planning, LexisNexis Risk Solutions
Mr. Hyde has been instrumental in LexisNexis Government Sector specifically in the strategy, design, and implementation of identity solutions focused on health and human services agencies nationwide. •    Experienced program manager who directed the implementation of the Florida... Read More →

Wednesday March 20, 2019 10:00am - 11:00am PDT
Key Ballroom 9 (2nd Floor)