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SCIOinspire’s Smith to speak at Las Vegas NHCAA conference on challenges in specialty pharmaceuticals and carve-out arrangements
Industry leader to de-mystify fraud, waste and abuse issues associated with infused or injected medications, and implantable devices
Hartford, CT - Nov 11, 2010 - SCIOinspire, Corp., a premier provider of analytics-driven business process solutions for health plans and hospitals, today announced that Rodger Smith, Senior Vice President for Audit and Recovery Services, will appear as a presenter at two sessions during the National Health Care Anti-Fraud Association’s (NHCAA) Annual Training Conference in Las Vegas, Nevada.
A full-day pre-conference program, titled "Investigating Pharmaceutical Fraud Schemes," will occur on Tuesday, November 16. Smith’s presentation, "Injected & Infused Specialty Pharmaceuticals" will be co-presented by Greg Hunter, Director of Provider Audit, of Neighborhood Health Plan in Massachusetts (NHP), a client of SCIOinspire. The presentation will cover opportunities and challenges presented in specialty pharmaceutical claims, as well as real-world examples from the program SCIOinspire has implemented for NHP. Smith’s second talk, a regular conference session entitled "Carve-Out Arrangements," will take place at 11:15 a.m. PST, Wednesday, November 17. He will focus on issues that arise in contractual arrangements with carve outs, including implantable devices and specialty pharmaceuticals.
"Specialty pharmaceuticals pose unique problems in the healthcare industry, given the complexity of care and billing for the services, the flood of new products entering the market and the costs for the services," Smith notes. "Similarly, carve-out payment arrangements present substantial challenges for payers if not handled correctly." "Fraud and abuse cases relating to infused and injected pharmaceuticals have become increasingly common," Hunter adds. "But, with proper education, payers can maximize overpayment identification and recovery outcomes."
Smith has more than 10 years of health insurance experience in the areas of litigation, fraud and abuse investigation, and claims cost management. Smith was a co-founder and principal of WayMark Associates LLC, a specialty claim overpayment identification and recovery firm established in 2006 and acquired by SCIOinspire in 2009, which provided retrospective audit services to healthcare payers. Prior to founding WayMark, Smith worked for Oxford Health Plans, a Connecticut-based health insurance company, and United Healthcare, which acquired Oxford in 2004. Prior to joining Oxford in 2000, Smith practiced law in New York City.
Hunter likewise has 11-plus years experience in the industry working for health insurers as well as entities providing services for payer organizations. He joined Neighborhood Health Plan in 2003, where he is responsible for key initiatives addressing claims overpayments and recoveries, including third-party liability, hospital bill auditing, and fraud and abuse investigations. Hunter has been a Certified Professional Coder since 2003 and has delivered presentations on cost containment at conferences across the country.
The National Health Care Anti-Fraud Association is the leading national organization focused exclusively on the fight against health care fraud. The NHCAA Annual Training Conference is recognized as the single most important health care anti-fraud national training venue. Educational sessions spotlight trends and emerging schemes, and bring together the industry’s leaders to share information on best practices to detect, investigate, prosecute and prevent fraud, waste and abuse.
About SCIOinspire
SCIOinspire provides analytics-driven business process solutions to health plans and hospitals, enabling the healthcare community to achieve measurable outcomes, cost savings and increased revenues. Offerings include care analytics, care management evaluation and support, third-party liability recovery, claim audit and overpayment services, data management, and actuarial services. SCIOinspire collaborates with clients through a unique delivery model that includes strategic consulting, analytics support, software-as-a-service technology platforms, and business process outsourcing and co-sourcing. To optimize cost-management outcomes for clients, SCIOinspire draws upon an expert team of clinical, actuarial, legal and analytical resources, complemented by technology and knowledge assets.
