• Showcasing one health plan’s process for creating a pre-payment system focused on reducing provider abrasion by paying more claims correctly the first time.

• Discussion around the alarming rise of unnecessary lab tests, and the money wasted with this.Implementing robust payment integrity measures to combat such waste and fraud.

This session will focus on:

1. California’s efforts to combat fraud, waste and abuse in Medi-Cal, California’s Medicaid program.

2. How California is exploiting available data and data sharing opportunities for purposes of Medicaid program integrity objectives.

3. A summary of program integrity best practices from the perspective of a Medicaid Program Integrity Director.

4. California’s future vision with regards to the use of data and data analytics to support its Medi-Cal fraud-control strategy.

Learning Objectives:

• Obtain program integrity best practices that can be leveraged by the participating entity.

• Discover new ways to exploit data to identify and develop actionable leads.

• Performance metrics and return on investment – ways to measure success.

• This session will explore how to identify and prevent opioid-related fraud within pharmacy claims, focusing on strategies to combat the opioid crisis while safeguarding healthcare resources.

• This session will explore how precision pharmacy can be used to optimize medication therapy for individual patients, leading to improved health outcomes while reducing overall healthcare costs.

• This session will bring together payers and providers to discuss the challenges and opportunities presented by healthcare mandates and electronic medical record systems. Participants will explore strategies for effective collaboration to improve patient care and reduce administrative burdens.

• This presentation will delve into the latest trends and tactics employed by fraudsters, providing actionable insights to safeguard your organization. Attendees will gain a comprehensive understanding of the evolving threat landscape, learn to identify red flags, and implement effective prevention strategies.