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Session Reserved

Track 1: Payment Integrity

Author:

Dave Cardelle

Chief Strategy Officer

AMS

Dave Cardelle, R.Ph., is on the executive team at AMS and serves as the Chief Strategy Officer. He leads a dedicated team of professionals focused on transforming the payment integrity (PI) industry. With a BS in Pharmacy from the Massachusetts College of Pharmacy in Boston, MA, Dave brings a unique blend of healthcare expertise and domain knowledge to his role.
As the CSO, Dave leverages years of experience in the PI industry, including working for both Payer and Provider organizations to help AMS grow through innovative product, sales, marketing, and client relationship strategies.
Throughout his career, Dave has consistently demonstrated a keen understanding of healthcare-related matters, a skill that proves invaluable in the context of payment integrity. His passion for advancing the industry and commitment to maintaining the highest standards of integrity have earned him a reputation as a true industry expert.

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Data Driven Investigations: Enhancing Payment Integrity Outcomes

Leveraging data analytics and advanced investigative tools to uncover potential FWA
Demonstrating the value of predictive modelling in targeting suspicious providers and claims

Track 1: Payment Integrity

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Reducing Fraud And Increasing Revenue Via Effective Coordination

Coordinating the efforts of credentialing/enrollment, audits, investigations (SIUs), provider sanctions, and policy
Very few insurance payers have all those groups working together in a coordinated effort to reduce fraud, increase revenue, and render excellent customer service to enrolled health care providers.

Track 1: Payment Integrity