Data Mining for Cost Recovery, Proactive Fraud Detection, & Compliance Monitoring

Mia Okinaga, VP, National Compliance Operations, Kaiser Permanente

How can your ethics and compliance department contribute to the bottom line?  With increasing pressures to reduce health care costs, particularly overhead, Kaiser Permanente, an integrated health care organization, developed a novel process of leveraging the data analysis capability of its compliance and auditing departments to identify overpayments to vendors and outside providers.  It is also used to proactively detect fraud, waste, and abuse, as mandated by Medicare Part D and other state and federal regulatory requirements.  

Kaiser uses internal and external data to identify patterns of activity that are red flags for fraud or theft committed on our organization, as well as to monitor compliance.  The data are also used as a starting point for scoping audits and compliance work plans.  In this session participants will learn practical, employable skills for identifying those red flags that can not only cost a company significant money, but may also signal unethical conduct.