Healthcare Fraud Investigations: Challenges and Solutions

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Healthcare fraud is among the most lucrative crimes in the world. It’s estimated that six per cent of global health spending (or $260 billion) is lost to fraud, waste and abuse (FWA) every year. And it affects everyone, driving up the cost of healthcare and lowering its quality.

Staying ahead of new fraud schemes and trends is challenging, with advances in technology at the core of the growing problem, as well as a key part of the solution. It’s critical that healthcare fraud fighters keep their skills and knowledge up to date.

Join Jo-Ellen Abou Nader, AVP, Pharmacy Audit & FWA at Prime Therapeutics, and Anne Mack, Senior Director, Pharmacy Audit & FWA at Prime Therapeutics, as they examine the challenges faced by today’s fraud fighters and explore solutions.

The webinar will cover:

The effect of healthcare fraud on the industry
Emerging healthcare fraud schemes
Fraud detection methods and tools
The latest fraud investigation techniques
Examples of successful fraud fighting programs and results

Webinar Presenter

Jo-Ellen Abou Nader and Anne Mack

Jo-Ellen Abou Nader
As AVP of Prime Therapeutics, Jo-Ellen Abou Nader is responsible for the network audit and fraud programs. She provides leadership in determining future strategy of prescription auditing and fighting fraud at Prime. Before joining Prime, she led fraud and multiple audit teams at Express Scripts for 17 years.
Jo-Ellen is a Certified Internal Auditor and a Certified Fraud Examiner. In addition, she hold a Certification in Risk Management Assurance from the Institute of Internal Auditors.

Anne Mack
Anne Mack, Senior Director, Pharmacy Audit & FWA, oversees Prime Therapeutics’ network audit and fraud operations. She executes strategic initiatives to combat fraud, waste and abuse involving pharmacies, prescribers and members. In addition to her 11 years at Prime, Mack served 18 years in various health plan leadership and operations roles. Her health plan experiences includes product administration, case management, analytics, compliance and internal audit.