NICB Medical Investigations Academy

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1 NICB Medical Investigations Academy The National Insurance Crime Bureau is pleased to announce the fall session of the Medical Investigations Academy. This training provides investigators in the insurance industry, law enforcement, and NICB the skills required to recognize and understand basic medical fraud and is intended for investigators new to medical fraud investigation. [NICB recommends that attendees take the NICTA online course Introduction to CPT Codes in Medical Billing Fraud, as a prerequisite prior to attending the Medical Investigations Academy to be best prepared for, and gain the most from, the CPT Coding course offered at the medical academy. The online medical course is located on the National Insurance Crime Training Academy (NICTA) website: The direct link to the medical courses is: If you are interested in taking one or more of the online courses, you will need to log in or sign up as a new student. If your company is a corporate license holder of NICTA, you will need to enter your company s corporate code after you log in, to bypass the payment option.] Below are the program details and registration form including the agenda and course descriptions. PLEASE REPRODUCE AND DISTRIBUTE THIS BULLETIN TO PERSONNEL WHO WISH TO ATTEND THIS ACADEMY. Date: October 26-29, 2015 (Sunday, Oct. 25, is a travel day and Thursday, Oct. 29, after 6:30PM, and/or Friday, Oct. 30, is a travel day). Location: NICB Headquarters Office, 1111 E. Touhy Avenue, Suite 400, Training Room, Des Plaines, IL Academy Eligibility: Eligibility for academy attendance is restricted to the direct (not contracted) employees of member companies. Additionally, government agencies and law enforcement are eligible to attend the academy on a space available basis if their current assignment involves the investigation of insurance crime. Limited Registration: Academy registration is limited to 30 students per session. If full, students will be placed on a waiting list for next scheduled academy. Registration Cost: $ per student How to Register: There are four ways you can register: 1. Online (This option is available to member companies only) Enter the member sonly section of the website. You will need a user id and password to log in. If you do not have one, contact Technical Support at ext. 7003). 2. registration form to Melitta Kewitz at 3. Fax registration to , Attn: Melitta Kewitz 4. Mail registration and check payment to, NICB, 1111 East Touhy Avenue, Suite 400, Des Plaines, IL 60018, Attn: Melitta Kewitz, Training Department. Payment Method Options: 1. Credit Card payments are accepted for online registrations only. We accept Visa, Mastercard, and American Express. 2. Check made payable to: National Insurance Crime Bureau. Mail payment to NICB, 1111 East Touhy Avenue, Suite 400, Des Plaines, IL 60018, Attn: Melitta Kewitz, Training Department. We request that payment be made prior to the academy.

2 Agenda All training classes will be conducted at the NICB Headquarters Office, 1111 E. Touhy Avenue, Suite 400, Des Plaines, IL, October 26-29, Classes begin Monday morning 8:00 am 4:30 pm, Students should make their travel arrangements to accommodate this schedule. The NICB will provide refreshments and lunch Monday Thursday. Please inform us of any specific dietary requirements/restrictions. Dress Code: Attire is BUSINESS CASUAL (no jeans, shorts, sweatshirts, t-shirts, or hats while attending classes, please). Hotel: If lodging is required, NICB has arranged for a block of rooms at the Radisson Chicago O Hare, 1450 East Touhy Avenue, Des Plaines, IL The discounted room rate per night is $99.00, plus 13.0% tax which includes a Hot American Breakfast Buffet for one person served each morning in Bakery Cafe and free high-speed Internet access. STUDENTS ARE RESPONSIBLE FOR MAKING AND PAYING FOR THEIR OWN HOTEL RESERVATIONS AT THE RADISSON CHICAGO O HARE. To receive the discounted rate, please contact the Radisson Chicago O Hare direct at and ask for Larry Holland, or direct to Let them know that you are with the group event, NICB Medical Investigations Academy. Hotel Location: The Radisson Hotel Chicago O Hare is 100% smoke-free with adjustable Sleep Number beds by Select Comfort, exclusive to Radisson hotels. This hotel is just across from the transportation hub of the Chicago O Hare Airport (ORD). For further information about the hotel, visit their website at Transportation: Airport to Hotel: The Radisson Chicago O Hare provides shuttle service from O Hare Airport to the hotel. Follow the signs to the BUS SHUTTLE CENTER. The signs will be hanging overhead at all domestic Terminals 1 through 3. When you get to the BUS SHUTTLE CENTER, look for the van that says Radisson Hotel- Chicago O Hare. NOTE: Shuttle runs fifteen minutes after, and fifteen minutes prior to each hour. It is recommended that you call ahead for best shuttle service. To arrange a pick up, please call the Radisson Hotel Chicago O Hare at The Radisson- Chicago O Hare does not provide shuttle service from Midway airport. If you are arriving at Midway, please call Right Transportation and arrange for service to the hotel. They can be reached at Transportation: Hotel to NICB & NICB to Hotel The Radisson Chicago O Hare will provide transportation to NICB each morning departing at 7:45am. At the end of each day, the Radisson shuttle will pick up students from NICB and take them back to the hotel. The Radisson is only 5 minutes to the NICB office. Transportation in the evenings after students have been shuttled back to the hotel will be at the students own expense. When booking your departure flight, please be sure to schedule the flight to depart on Friday or at the earliest 6:30 pm on Thursday. The Academy is scheduled to end at 4:30pm on Thursday. The hotel shuttle will pick you up from NICB and take you back to the hotel, or with prior scheduling, the hotel shuttle will pick you up from NICB and take you direct to the airport. If you need to extend your check-out time please make arrangements with the hotel front desk.

3 REGISTRATION FORM NICB MEDICAL INVESTIGATIONS ACADEMY All classes conducted at NICB Headquarters Office Training Facility October 26-29, 2015 Classes start Monday at until 4:30pm Please note - this training is intended for investigators new to medical fraud investigation. Name: Title: (As it should appear on Certificate of Completion) (Please print or type legibly) Company/Agency Name: Address: City: State: Zip: Phone: Buffet lunch is provided each day; please inform us of any specific dietary requirements/restrictions: Hotel: If lodging is required, NICB has arranged for a block of rooms at the Radisson Chicago O Hare, 1450 East Touhy Avenue, Des Plaines, IL The discounted room rate per night is $99.00, plus 13.0% tax. which includes a Hot American Breakfast Buffet for one person served each morning in Bakery Cafe and free high-speed Internet access. STUDENTS ARE RESPONSIBLE FOR MAKING AND PAYING FOR THEIR OWN HOTEL RESERVATIONS AT THE RADISSON CHICAGO O HARE. To receive the discounted rate, please contact the Radisson Chicago O Hare direct at and ask for Larry Holland, or direct to Let them know that you are with the group event, NICB Medical Investigations Academy. How to Register: There are four ways you can register: 1. Online (This option is available to member companies only) Enter the membersonly section of the website. You will need a user id and password to log in. If you do not have one, contact Technical Support at ext. 7003). 2. registration form to Melitta Kewitz at 3. Fax registration to , Attn: Melitta Kewitz 4. Mail registration and check payment to, NICB, 1111 East Touhy Avenue, Suite 400, Des Plaines, IL 60018, Attn: Melitta Kewitz, Training Department. Payment Method Options Registration Fee: $ per student 1. Credit Card payments are accepted for online registrations only. We accept Visa, Mastercard, and American Express. 2. Check made payable to: National Insurance Crime Bureau. Mail payment to NICB, 1111 East Touhy Avenue, Suite 400, Des Plaines, IL 60018, Attn: Melitta Kewitz, Training Department. We request that payment be made prior to the academy. If you do not receive a confirmation letter within 3 days of submitting your registration form, please contact Melitta Kewitz at ext or Registration Cancellation Policy: Cancellations received two weeks prior to the academy are refundable. Cancellations received within the two weeks prior to the academy are refundable less a $50 registration service charge. Cancellations received after the start of the class, are not refundable, but the fee may be applied toward a future Academy session. Please note that if you do not cancel and do not attend, you are still responsible for payment. Substitutions may be made at any time if you are unable to attend the Academy.

4 Medical Investigations Academy October 26-29, 2015 Monday, October 26 9:00am Welcome/Introductions MIA Training Team Medical Billing Forms, CPT Coding & HCPCS Scott Arena, Special Agent, MFTF, Houston, TX Raun Bass, Field Information Analyst, MFTF, Houston, TX Break as necessary 12:00pm CPT Coding & HCPCS (continued) Scott Arena, Special Agent, MFTF, Houston, TX Raun Bass, Field Information Analyst, MFTF, Houston, TX 2:45pm 3:00-4:30pm ICD-10 Codes & Classifications Dr. Lawrence Stolar, BS DC MCS-P, Medical Compliance & Insurance Consultants Grapevine, TX 5:00 7:00pm Welcome Reception The Radisson Tuesday, October 27 10:00am 10:15am Medical Bill Review Kymberly McGhee, Special Agent, MFTF, Edison, NJ James Keith, Special Agent, MFTF, Chicago, IL Forensic & Compliance Case Review Dr. Lawrence Stolar, BS DC MCS-P, Medical Compliance & Insurance Consultants Grapevine, TX

5 12:00pm 2:30pm 2:45-4:30pm Drug Diversion Ken Pedigo, Special Agent, Ruby, VA Internet Searching Aaron Soline, Manager, Data Analytics, Des Plaines, IL Wednesday, October 28 9:00am 9:15am Aggregated Medical Database Jamie Walsh, Manager, NICB Data Analytics, Des Plaines, IL Mike McKee, Sr. Special Agent, Alta Loma, CA Diagnostic Testing Mike McKee, Sr. Special Agent, Alta Loma, CA Break as necessary 12:00pm 2:30pm 2:45pm-4:30pm Clinic Inspections Jeff DeSimone, Special Agent, Melville, NY DME Overview & DME Case Study Vincent Nitti, Special Agent, MFTF, Melville, NY Thursday, October 29 Chiropractic Made Simple Dr. Matt Kuschner, DC, Medical Investigator, Travelers, Melville, NY Break as necessary 12:00pm 2:45pm 3:00pm-4:30pm Chiropractic Made Simple (continued) Medical Investigations Legal Overview Jim Hertz, Associate General Counsel, Des Plaines, IL Wrap Up & Questions

6 NICB Medical Investigations Academy Course Descriptions CPT Coding & HCPCS This course explains how CPT codes are used and what they mean. CPT is defined and why its important to know which CPT codes were billed when evaluating a case. It covers evaluation and management and the key components in selecting the appropriate level of an E/M service, code modifiers, and treatment. It explains the difference between HCPCS and CPT codes. Example of HCPCS codes for durable medical equipment will be explained. ICD-10 Codes & Classifications This course will cover the history of ICD, the definition of the ICD-10 code and the importance for a medical investigator to understand these codes will be addressed. This course will also discuss where these codes could be found on medical documents and how to use these codes in medical bill reviews. The objective is to be able to determine if the treatment, when presented with an ICD-10 code on a medical treatment record bill is consistent with the ICD-10 code. Medical Billing Forms & Medical Bill Review In this course the topics discussed will be, S.O.A.P. notes, billing sheets, the elements of a medical bill, explanation of benefits and explanation of reimbursement. Each one of these topics will be presented in detail and will conclude with practical exercises. Forensic & Compliance Case Review - This presentation is an actual audit of motor vehicle accident case. The provider's examination, diagnosis, and treatment plan will be dissected to expose fraudulent diagnosis and treatment. This presentation will explain the goals and appropriate billing of therapy modalities and procedures, and how to identify fraud by comparing the provider's treatment notes to the billing records. Durable Medical Equipment Overview This course will cover several examples of the most common durable medical equipment. DME trends and schemes will be discussed and how DME fraud continues to be a significant for of insurance fraud. The student will be able to describe areas of potential fraud with DME and to know what equipment is being billed and supplied. DME Case Study This Durable Medical Equipment case study outlines an example of a DME case. Drug Diversion Drug diversion will be defined, some of the investigative strategies involved with diversion will be described and the crimes associated with drug diversion will be discussed. Clinic Inspections This course outlines how to prepare and conduct a clinic inspection from beginning to end. Aggregated Medical Database This course defines the aggregated medical database and provides an overview of this database. Internet Searching - This course begins with a detailed, step-by-step instruction on how to navigate the NICB website. It provides information about NICB and the many services offered to insurers, law enforcement agencies, and representatives of the public to prevent and combat insurance fraud through data analytics, investigations, training, legislative advocacy and public awareness. Internet searching is also covered in-depth by providing useful information on how to find hidden sites deep within the web to aid with investigations. Diagnostic Testing This course identifies and describes some common diagnostic tests billed by medical professionals. It covers who can perform tests, the purpose, how they are performed, and how they can be abused. Chiropractic Made Simple This course was designed as training for investigators and claims personnel to be trained in the basics of Chiropractic Fraud Identification and Investigation. Upon completion, attendees will have a basic understanding of chiropractic/medical fraud & abuse trends in the insurance industry. They will have a basic understanding of how to identify chiropractic/medical fraud & abuse. In addition, attendees will be able to conduct basic reviews of chiropractic/medical documentation in line with billings and will be able to identify questionable claims through red flag classifications and indicators. Medical Investigation Legal Overview This presentation covers common types of claims involving medical fraud, what indicators to look for in medical cases and important steps to take. Legal procedures will be discussed; state rules, typical cases, criminal prosecution, recent initiatives, criminal charges and affirmative civil causes of action.

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