Whether you're a commercial MCO, state health plan or state or federal insurer – you need to be asking yourself the multimillion-dollar question: Are you covering who you think you're covering?

This webinar will help you:

  • Understand the most important questions you should be asking to determine the rigor of current eligibility checks.
  • Explore your data sources and identify the analytical methods best suited to unearthing fraud and abuse.
  • Hear about the real-world success of five SAS customers – their methods and their results.

Presenters

Jay King
Manager, Advanced Analytics Lab, SAS

Jay King is a manager in the Advanced Analytics Lab at SAS, where he manages a group of statisticians specializing in the use of analytical methods to detect fraud in health claims. King holds a bachelor's in mathematics from the University of North Carolina at Wilmington, and a master's in applied mathematics from North Carolina State University. He is a member of the American Statistical Association. King has been an analytical consultant at SAS for 12 years and has more than 19 years of experience in statistical and mathematical consulting. His experience includes risk evaluation in banking as well as property casualty and health insurance.

Julie Malida, FSA, MAAA
Principal for Health Care Fraud, SAS

Julie Malida is the Principal for Health Care Fraud at SAS in the Fraud and Financial Crimes global practice. She is responsible for the strategic direction of the SAS® Fraud Framework solution set as it pertains to the global health care industry, as well as the health care fraud domain expert.

Malida has devoted more than 26 years to the health insurance industry, focusing on managed care and cost containment in medical claims. Most recently, she served as President of The Sentinel Group, a premier health care anti-fraud organization serving insurance companies, third-party administrators, workers' compensation entities, P&C carriers and other cost containment organizations.
She is a Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries. She earned a Bachelor of Science degree in mathematics and computer science from DePaul University.

Key Point

"With the adoption of the Affordable Care Act an estimated 17 million more people will be eligible to be added to the Medicaid rosters in 2014. That change will lead to legitimate confusion, and also to fraudsters looking to use that confusion to their advantage."

Julie Malida, FSA, MAAA
Principal for Health Care Fraud, SAS

Register Now