Fraud, Waste, and Abuse in Claim Payment Models


Fraud, Waste, and Abuse in Claim Payment Models: Modern Healthcare Payment Systems & Using Artificial Intelligence to Increase Payment Integrity


This session covers background and lessons learned from US healthcare reimbursement models, clearinghouses & claims processing, provider relations, and claims adjudication. We then explore case studies of how integrating robust machine learning into fraud, waste, and abuse remediation in worldwide markets can vastly improve payment integrity and reduce healthcare expenditure. 


Chris Garson, Principal Consultant, Health Innovation Advisory
Kasey Sousa, JD, CEO, PrecisionGx, Inc.

Target audience:

Payers/insurance company operations and executives, data analysts, payment auditors, clearing house operations, and payment integrity operations.

Learning Objectives:

  • History of claims processing in US
  • Common problems & solutions of claims submission and payment processing for payers and providers in the US
  • Benefits of centralized systems
  • Extent of¬†fraud, waste, and abuse in certain healthcare markets
  • How machine learning and neural networks can better detect and take action on¬†fraud, waste, and abuse

 Date: 27 November 2018

 Timing: 09:00hrs to 13:00hrs

 Registration Fee: USD 350                     


To download the workshop flyer, please click here: