Dr Penny Dash
Chair
North West London Integrated Care System
Rebecca Baldwin
Portfolio Director
Women’s Health Innovation Series
The session will cover two drug categories and medications commonly used and current trends of fraud, waste and abuse. The four medications include GLP-1 (Ozempic/Mounjaro) and Antivirals combinations (Descovy & Biktarvy). Each drug will cover its directed use by manufacturers and common side effects, this will segue into issues of patient harm being inappropriately prescribed and its financial impact on health plans. Data analytic tactics using patient historical clinical indications to identify potential FWA providers/members and approaches to address outliers. The aftermath of inappropriately prescribing causing pharmacy inventory shortages, diversion, misbranding and counterfeit production by fraudsters for profit.
Learning Objectives:
1) Identifying counterfeit medications mentioned in presentation.
2) Implementation of provider education, recoveries and cost-saving best practices
Eric Renteria
Senior Fraud Investigator
L.A. Care Health Plan
Angela Zigler
Special Agent
Food and Drug Administration Office of Criminal Investigation
CEU Eligibility: COC, CPC, CPC-P, CPB, CPPM
In the ever-evolving landscape of healthcare, balancing cost containment with maintaining strong provider relationships is a critical challenge. This session will explore effective strategies to control costs while fostering positive, collaborative relationships with providers. Attendees will gain insights into practical approaches and best practices that align financial objectives with the goal of delivering high-quality patient care.
Learning Objectives:
- Collaborative Approaches to Payment Integrity
- Efficient Billing and Coding Practices
- Provider Education and Training
- Monitoring and Continuous Improvement
Jonique Dietzen
Payment Integrity Director
CareOregon
With over 18 years of experience in healthcare billing and finance, I am a certified professional coder dedicated to ensuring accurate claims and proper reimbursement for providers. Having worked extensively on the provider side in finance and revenue cycle, I bring wealth of knowledge to the table, particularly in processing and payment integrity.
Throughout my career, I have gained a comprehensive understanding of billing challenges from both perspectives. This unique insight drives my commitment to improving billing practices and advocating for provider education. I continue to leverage my expertise to enhance billing processes and support providers in navigating the complexities of healthcare finance.
Erik Carter-Nadeau
Operations Manager, Provider Network
CareOregon
With over a decade in healthcare leadership, I am passionate about fostering provider engagement and delivering strategic support to improve the health of Oregonians, particularly in rural and underserved areas. As a native Oregonian, growing up in these communities across my state has provided me with unique insights into the cultural and geographic factors that influence healthcare delivery. I am committed to leveraging this understanding to enhance quality, access, and equity in healthcare for all Oregonians.
In the ever-evolving landscape of healthcare, balancing cost containment with maintaining strong provider relationships is a critical challenge. This session will explore effective strategies to control costs while fostering positive, collaborative relationships with providers. Attendees will gain insights into practical approaches and best practices that align financial objectives with the goal of delivering high-quality patient care.
Learning Objectives:
- Collaborative Approaches to Payment Integrity
- Efficient Billing and Coding Practices
- Provider Education and Training
- Monitoring and Continuous Improvement
Jonique Dietzen
Payment Integrity Director
CareOregon
With over 18 years of experience in healthcare billing and finance, I am a certified professional coder dedicated to ensuring accurate claims and proper reimbursement for providers. Having worked extensively on the provider side in finance and revenue cycle, I bring wealth of knowledge to the table, particularly in processing and payment integrity.
Throughout my career, I have gained a comprehensive understanding of billing challenges from both perspectives. This unique insight drives my commitment to improving billing practices and advocating for provider education. I continue to leverage my expertise to enhance billing processes and support providers in navigating the complexities of healthcare finance.
Erik Carter-Nadeau
Operations Manager, Provider Network
CareOregon
With over a decade in healthcare leadership, I am passionate about fostering provider engagement and delivering strategic support to improve the health of Oregonians, particularly in rural and underserved areas. As a native Oregonian, growing up in these communities across my state has provided me with unique insights into the cultural and geographic factors that influence healthcare delivery. I am committed to leveraging this understanding to enhance quality, access, and equity in healthcare for all Oregonians.
In the ever-evolving landscape of healthcare, balancing cost containment with maintaining strong provider relationships is a critical challenge. This session will explore effective strategies to control costs while fostering positive, collaborative relationships with providers. Attendees will gain insights into practical approaches and best practices that align financial objectives with the goal of delivering high-quality patient care.
Learning Objectives:
- Collaborative Approaches to Payment Integrity
- Efficient Billing and Coding Practices
- Provider Education and Training
- Monitoring and Continuous Improvement
Jonique Dietzen
Payment Integrity Director
CareOregon
With over 18 years of experience in healthcare billing and finance, I am a certified professional coder dedicated to ensuring accurate claims and proper reimbursement for providers. Having worked extensively on the provider side in finance and revenue cycle, I bring wealth of knowledge to the table, particularly in processing and payment integrity.
Throughout my career, I have gained a comprehensive understanding of billing challenges from both perspectives. This unique insight drives my commitment to improving billing practices and advocating for provider education. I continue to leverage my expertise to enhance billing processes and support providers in navigating the complexities of healthcare finance.
Erik Carter-Nadeau
Operations Manager, Provider Network
CareOregon
With over a decade in healthcare leadership, I am passionate about fostering provider engagement and delivering strategic support to improve the health of Oregonians, particularly in rural and underserved areas. As a native Oregonian, growing up in these communities across my state has provided me with unique insights into the cultural and geographic factors that influence healthcare delivery. I am committed to leveraging this understanding to enhance quality, access, and equity in healthcare for all Oregonians.
- Break out groups to discuss this topic and ask questions of the group to CMS leaders.