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AHIP Webinar - Recording Available Now

April 7th, 2022 at 1:00pm EDT

AI's Next Generation: Strengthening Fraud Detection Within Senior Care

With today’s growing aging population, healthcare fraudsters are redefining the term “Golden Years.” Vulnerable to excessive billing, wasteful treatments and other corrupt activity, an enhanced approach is needed to protect health plans and our elderly population from healthcare fraud, waste and abuse.

In this webinar, Shift experts share experiences and strategies investigating healthcare-payment fraud, waste, and abuse, and provide insights into the fraudsters taking advantage of the vulnerable elderly population.

What You'll Learn:

  • How plans can apply AI-powered, actionable insights to better uncover and investigate suspicious activity
  • Emerging trends and schemes impacting long term care
  • How data and technology can enable plans to better their provider networks, facilities and overall quality of care for vulnerable populations

Speakers

Mandy Fogle-1-1
Mandy Fogle

Healthcare Value Engineering, Shift Technology

Mandy is a subject matter expert focusing on improper payments within the Healthcare Industry. She brings more than 25 years of experience from IBM, where she led development teams and their delivery of risk management solutions to address client pain points. Her subject matter expertise in these industries provides insight to clients in the area of risk/compliance, fraud, waste and abuse. As a current solution lead, Mandy assists clients with understanding areas of risk and exposures across organizational hierarchy, gaps in policies and processes, the value to leverage advanced analytical offerings to address fraud, abuse, and waste within an organization.

Peter-Kapasakis-square
Peter Kapasakis

Senior Healthcare Customer Success Manager, Shift Technology

Peter has more than 20 years of experience in the development of fraud prevention systems and analytical platforms for medical, pharmacy and behavioral health in the commercial and public healthcare systems. Prior to joining Shift, Peter held fraud related positions with Alivia Analytics, General Dynamics, MITRE, Verisk Health, Coventry Healthcare, and Magellan Health Services. Peter holds a Master’s degree in healthcare policy and management and degrees in experimental psychology, applied social research from the State University of New York at Stony Brook. He is a member of Alpha Eta honor society for Allied Health and the NHCAA.

Lisa-Smith-square
Lisa Novajosky Smith

Account Executive, Shift Technology

Using innovative and proven solutions, Lisa’s expertise is held in high regard as a successful business solution, development and sales leader for over 35 years with IBM and Shift Technology. Collaborating with Healthcare Payers and Providers, government agencies and non-profit organizations, she addresses citizen, patient and global challenges. Recognized as a ‘problem identifier and problem anticipator’ Lisa keeps the focus on reducing cost and loss, while improving access and delivery. Her insights led to the development and delivery of enterprise-wide solutions that included interoperability + digital transformation, modernization in health and social programs, opioid tracking, electronic visit verification, program integrity & case/data management, global population health, and AI with advanced analytics.

As a small-time philanthropist, Lisa’s passion is global. Colleagues in Care’s global healthcare model WHAG is changing the way healthcare is delivered in the underserved regions of the world. Her network includes UN, Clinton Foundation/CGI/Health Access Initiative, RFK Center-Human Rights, World Community Grid, and Penn State Alumni.