- Alex Filimon
- Al Langley
- Ann Foran
- Carla Ryan
- Chester Brown
- Chris Mathers
- Darrell Gaudet
- Jacques Poitras
- Jeff Alcock
- Jim Carroll
- Joel Alleyne
- John Cancilla
- John Crawford
- John Lyons
- Ken Froese
- Mark Hartlen
- Maureen Ward
- Mike Mandel
- Richard Lussier
- Rita Estwick
- Rodney Conoley
- Sandy Winfield
- Scott Moore
- Terry Scott
- Tom Blackwell
- William Hiltz
Alex Filimon - Novus Consulting, Dalhousie University Lecturer
For the past ten years, Alex Filimon has provided external and internal clients with business intelligence, strategic planning, marketing research, database marketing, and international marketing services. Prior to earning his MBA degree from Dalhousie University, Alex held management positions with a number of major European IT companies. In the last seven years, Alex has spearheaded the development of his consulting practice in Nova Scotia. He has coordinated and implemented successful knowledge discovery and market research projects for a variety of major national companies, the Canadian Government, non-profit organizations, and a number of Atlantic Canadian and international enterprises. In addition to his marketing savvy, Alex's strengths include analytical and quantitative skills using the latest techniques and applications in statistics and data mining. Alex is the only Canadian university lecturer profiled as a "success story" by the SAS Institute in recognition of his work in the Informatics field. Alex is known for his seminars and lectures about data mining, marketing
research, CRM technologies, and marketing strategy. His Informatics
courses (taught at St. Mary's, Dalhousie and Acadia Universities) are based on his business expertise acquired while working with numerous clients. Currently, Alex's research work is focused on developing better analytical methodologies for knowledge discovery in medical databases and he is expecting to finish his doctorate within 16 months.
Presenting: Data Mining: How To Find The "Needle In The Haystack"
The presentation will summarize the main advanced analytical techniques used to prevent health insurance fraud. The speaker will review current challenges faced by health care insurers and present ways of minimizing the monetary losses by using various data mining techniques. Examples and case studies will be discussed with participants.
Al Langley - Executive Director, Association of Certified Forensic Investigators of Canada
Alan Langley, Executive Director, Association of Certified Forensic Investigators, has performed audits and investigations in Canada, the US and UK, including non-profit housing corporations. Since 1987 he has been providing fraud-related services to both the private and public sectors and has lectured to accounting bodies, government, educational facilities and businesses on fraud-related issues.
Presenting: Understanding Forensic Investigations
In order to meet the challenges that fraud presents today, an investigator must be able to effectively and efficiently resolve related and sometimes sensitive issues in a timely fashion through various investigative techniques. But just what is a forensic investigation and how does it differ from such other types of reviews? What are the most common, and not so common, perils and pitfalls that you should be aware of and what are the various techniques that the professionals use? This interactive session, using a case study, is designed to be both entertaining as well as informative.
Ann Foran - Medavie Blue Cross, Manager, Nova Scotia Prescription Monitoring Program
Ann holds a bachelors degree in psychology and a masters degree in education / counselling through Dalhousie University, and is a Certified Disability Management Professional through NIDMAR (National Institute if Disability Management and Research). She has over 15 years experience in the life and disability industry, which has focused on working closely with various health care providers and stakeholders. In her current role, Ann is responsible for the management of Nova Scotia's Prescription Monitoring Program. Administration of this program is contracted to Medavie through the Department of Health. Medavie Blue Cross has worked closely with the Nova Scotia Department of Health as a partner since 1969, administering the provinces MSI programs.
Presenting: Prescription Monitoring in Nova Scotia
The increasing abuse of prescription medications has prompted the development and enhancement of "Prescription Monitoring Programs" in both Canada and the United States. These programs monitor and inform with respect to prescribing patterns and patient use of controlled drugs. This presentation will provide an overview of the application developed by Medavie Blue Cross in response to a request by the Nova Scotia Department of Health. The features and benefits of this real-time, on-line program, and its use to date within Nova Scotia will be reviewed.
Carla Ryan - Medavie Blue Cross, CHCAA Vice-Chair
Carla Ryan of Medavie Blue Cross was elected as CHCAA Vice Chair for 2006. Ms. Ryan has worked for 12 years in both private and government business portfolios. She is currently the Director of Provider Affairs and is responsible for Audit Services, Provider Services and Provider Relations. Her accountabilities include corporate provider relations, healthcare supplier management, healthcare professional contracts, provider agreements, credentialing, quality control, audit profiling and investigations. In addition, Ms. Ryan has been a board director with the CHCAA for four years.
Chester Brown - MD, Ontario Ministry of Health and Long-Term Care
Dr. Chester Brown is currently the Manager of Monitoring and Control for Provider Services Branch of the Ontario Ministry of Health and Long Term Care (MOHLTC). He has been medical consultant to the Ontario Ministry of Health for many years, including 6 years as consultant on analyzing billing patterns of providers. Dr. Brown is a former naval officer retiring as a Surgeon Commander C.D., a former Medical Liaison Officer at the embassy of Canada in Washington D.C., and has experience as an emergency medicine physician and family physician. Dr. Brown holds a B.. (Hons.) Royal Military College (RMC), M.A. from Carleton University in History with a major in international law and the law of treaties, and M.D. from Queen's University.
Presenting: Best Practices In Provider Audit - Cory Report
The presentation will focus on the key statements made in the Cory Report. The presentation will highlight the implications in dealing with incorrect, inappropriate and fraudulent billing. It is suggested that the impact will affect how all the provinces monitor claims data and respond to questionable billing practices. The implications may extend to how the courts deal with issues of alleged fraudulent billing. The Cory Report will be far reaching in its influence and will dictate change in the medical audit process in this country.
Chris Mathers - International Security Expert, chrismathers inc.
For 20 years, Chris Mathers was employed as an undercover agent for the RCMP, personally infiltrating criminal groups in Europe, the Caribbean and Latin America. He conducted numerous international investigations for FBI, DEA, US Customs Service, Interpol, Scotland Yard and various European federal agencies. He left law enforcement to set up and run the Corporate Intelligence Division of one of the largest forensic accounting firms in the world. Chris now operates his own crime and risk consulting firm providing advice to a select group of international clients in the areas of organized crime, terror, fraud and money laundering. Chris' new book, CRIME SCHOOL: Money Laundering became a national bestseller in only 4 weeks. Humorous in places, deadly serious in others, Crime School gives the reader an insider's look at the stark realities of the criminal underworld. Chris is a popular media commentator and speaker. He has served as a consultant on several feature films and documentaries relating to organized crime, espionage and money laundering. Whether the audiences are front-line staff, sales managers, corporate executives, teachers, entrepreneurs, trades people or parents, there are many lessons to be learned from his life of crime. Touching on issues from security, hiring decisions and back-ground checks to money-laundering schemes, corporate fraud, bribery, blackmail, extortion and more; Chris offers wise insights on human character and organizational culture that can help you to spot and avoid the perils of white collar crime. Chris easily links his experience and knowledge of the underworld with the interests and concerns of a particular sector. A compelling storyteller with many outrageous and entertaining tales to tell, Mathers is a unique, humorous and fascinating speaker.
Presenting: Organized Crime, Terrorism, and Other Bad Things
This session will provide an overview of domestic and international issues linking Organized Crime and Extremist activity. It will address Canada as a haven for crime and terror, historic commonalities between extremist groups, and public perceptions of criminality and the effect on law enforcement and intelligence.
Darrell Gaudet - Sergeant, Halifax Regional Police
Sergeant Darrell Gaudet is a member of the Halifax Regional Police and been so for 18 years. He graduated from Saint Mary's University in 1986 with a Bachelor of Arts Major in Sociology and Criminology. Darrell has received extensive training in interviewing and interrogation and is a Certified Forensic Polygraphist. Darrell has conducted thousands of interviews both in criminal investigations and in the detection of deception in Human Resource interviews. He has been conducting polygraph examinations since 1996. Darrell has lectured on interviewing and interrogation at the Canadian Police College, CCRA, Nova Scotia Department of Justice, Nova Scotia Department of Labour, Nova Scotia Gaming and Alcohol Authority, Department of Natural Resources, Bermuda Police Training Academy and numerous other police agencies and private corporations.
Presenting: Get The Answers You Want - The Right Way
Jacques Poitras - Provincial Affairs Reporter, CBC Radio, New Brunswick
Jacques Poitras has been CBC Radio's provincial affairs reporter in New Brunswick since 2000. He is a former Moncton bureau chief with the New Brunswick Telegraph-Journal, and previously worked on Parliament Hill in Ottawa, in Kingston, Ont., and in Prague, Czech Republic. He has also appeared on Radio-Canada, National Public Radio in the United States, and the BBC. He has reported on the crash of Swissair Flight 111, the Native fishing dispute at Burnt Church, and the impact of September 11 on Canadian and U.S. border communities. He is the author of The Right Fight: Bernard Lord and the Conservative Dilemma. The book was published by Goose Lane Editions in 2004 and was shortlisted for the Atlantic Independent Booksellers' Choice Award. Poitras was the only Canadian recipient of a 2005 Commonwealth Broadcasting Association travel bursary, which he used to prepare a documentary series on the call-centre industry in India. He has received a National Newspaper Award, and he won the top national feature reporting award from the Radio and Television News Directors Association of Canada two years in a row. His work has also been honoured by Amnesty International.
Presenting: Miramichi Hospital Fraud Case
"CAPTAIN DAN'S FINAL INVESTIGATION" In early 2006, the community of Miramichi, New Brunswick was shocked when three senior hospital executives and a provincial court judge - who'd chaired the hospital board - were sent to prison for fraud. They were convicted of using shell companies, double billing and inflated bonuses to defraud the hospital of close to $1 million. CBC Radio's provincial affairs reporter in New Brunswick, Jacques Poitras, tells the story of the two unlikely heroes in the case: A retired police chief named Dan Allen and an elderly nun, Helen Burns. As volunteer members of the hospital board, they pushed for greater transparency and accountability. Their efforts eventually led New Brunswick's Minister of Health and the RCMP commercial crime squad to open investigations. Poitras's presentation is adapted from his radio documentary, "Captain Dan's Final Investigation," which aired on CBC Radio's Maritime Magazine in June 2006. It featured never-before-heard audio recordings of board meetings at which Dan Allen and Helen Burns confronted hospital executives about questionable expense account claims.
Jeff Alcock - Manulife, CHCAA Chair
Jeff Alcock, HBA, of Manulife Financial was elected as CHCAA's Chair for 2006. Jeff is the Manager of Investigative Services for Manulife Financial Group Benefits. He is responsible for leading a team of experts comprised of investigators, claims analysts, and industry consultants working to at the forefront of Manulife's efforts to protect group benefits plans from the harmful effects of fraud and abuse. Jeff is a graduate of Wilfrid Laurier University in Waterloo and is an Associate member of the Association of Certified Fraud Examiners and the National Health Care Anti-Fraud Association in the United States. He has served on the board of the CHCAA for three years prior to becoming Chair.
Presenting: Raising Public Fraud Awareness Through A Dynamic Website
Raising fraud awareness is key to managing the risk of fraud and abuse. A well-designed web site can be an effective communications tool. Participants in this workshop will have an opportunity to discuss and learn about: basic web site structure recommendations, types of information to include on the site, advantages and disadvantages as well as cautions and pitfalls to be aware of. The workshop will include an exercise to create a web site communications plan.
Jim Carroll - Platoon Commander, Patrol Services, Royal Newfoundland Constabulary
Inspector Jim Carroll has been a member of the Royal Newfoundland Constabulary for the past 25 years. His present assignment is that of Platoon Commander, Patrol Services. During his career he has been assigned to several investigative units such as, but not limited to: He spent 15 years with the R.N.C. Tactics and Rescue Unit with the last five (5) years as Team Leader. Before assuming his present duty, Inspector Carroll was assigned File Manager to an investigation / probe into the use / abuse of oxycontin within R.N.C. jurisdiction. This investigation lasted almost two years.
Presenting: Oxycontin - Abuse And Investigation
This presentation is comprised of a Power Point Format accompanied by Narrative descriptions on events uncovered by R.N.C. / RCMP intelligence probe into the use / abuse of the narcotic prescription drug, oxycontin. It will cover the impact this drug had in Newfoundland and Labrador and in particular, St. John's. The circumstances that led to the uncovering of this drug, the spin off crimes related to it, the response of the R.N.C. and the Provincial Government and lastly the pro-active approach taken including one of the most comprehensive, multi-faceted investigations undertaken by the R.N.C. utilizing the expert direction and services of undercover operators by the RCMP.
Joel Alleyne - Executive Director, Canadian Health Care Anti-Fraud Association
Mr. Alleyne has worked with management in several organizations. His work has included work with Senior Executives on Business and Organizational Strategy as well as Strategic Information and Technology Planning. Over the years, Mr. Alleyne has worked with electronic commerce in the insurance and health care industries in Canada and the United States. He has been involved with Canadian initiatives to implements and leverage electronic commerce and new media as well as the development of commercial claims systems products. Joel has worked with organizations across North America and the Caribbean and is a recognized expert in electronic commerce and new media - and related issues such as privacy, security, confidentiality and fraud. He is actively involved in research in the area of Information Technology and Organizational Change, New Media and Electronic Commerce. He is an active participant and research assistant with the McLuhan Center for Culture and Technology at the University of Toronto. A grad student with the Faculty of Information Studies and the Knowledge Media Design Institute, University of Toronto. As well, he is a faculty member with the Kaieteur Institute for Knowledge Management.
John Cancilla - Director of Compliance Branch, Regulatory Services Division, Workplace Safety & Insurance Board
John Cancilla is the Director of the Compliance Branch of the Workplace Safety and Insurance Board of Ontario (WSIB). The WSIB oversees Ontario's workplace safety education and training system, provides disability benefits, monitors the quality of health care, and assists in early and safe return to work. Mr. Cancilla has been employed with the WSIB since 1990 and has been actively involved in WSIB's fraud and non-compliance programs since 1997. Mr. Cancilla has held a variety of positions within the WSIB's Regulatory Services Area (formerly Special Investigations Branch) including his current position of Director of the Compliance Branch. The Compliance Branch administers the WSIB's surveillance program, anonymous call centre and fraud analysis area.
Presenting: Compliance Continuum - Avoid The Pendulum
Many regulatory and enforcement agencies have dealt with the apparent disconnect between their role of enforcing legislation and the ongoing objective of improved customer service. This perceived dichotomy often results in a pendulum swing between strong enforcement programs and customer service focused activities. The Workplace Safety and Insurance Board of Ontario has approached this issue through a compliance model that addresses non-compliance through a continuum of activity. This allows a broader spectrum of compliance activities while ensuring enforcement /prosecution activities are directed at the most significant cases of fraud and wrongdoing. This presentation will overview the WSIB's compliance model and its programs to address fraud and non-compliance.
John Crawford - BSc (Hons), MSc, PhD (Path), DC, FCCSS(C)
Dr. Crawford attained Honours BSc (Hons) and MSc degrees (Microbiology & Immunology) from the University of Western Ontario, and a PhD (Pathology) from the University of Toronto Medical School. He subsequently graduated cum laude from the Canadian Memorial Chiropractic College, Toronto, ON. He is a Fellow of the Canadian College of Chiropractic Sports Sciences (Canada) and is also certified and licensed under the Acupuncture Council of Ontario to practice acupuncture. Dr. Crawford has been an educator since 1973, lecturing in the fields of Microbiology, Anatomy, Physiology, Pathology Neurology and Clinical Diagnosis, to professional health care students including nurses, chiropractors, naturopaths, massage therapists, dental, medical and paramedic students. He has served as an Independent Physical Examiner since 1986 in both clinical practice and as a rostered DAC assessor with the Financial Services Commission of Ontario since 1995. Dr. Crawford is the author of a number of scientific publications and health-realted articles. He continues to perform independent physical assessments, reviews insurance claims and currently engages in part-time clinical practice.
Presenting: Case-oriented Reviews of Common Practices in Alternative Health Care Clinical Settings
Dr. Crawford's lecture will focus on the common and frequent billing practices observed from various alternative health care professions including rehabilitation, chiropractic, massage therapy and acupuncture. Specific details derived from actual case files will be presented and discussed as to their necessity and efficacy from a clinical perspective. The presentation is designed to both inform and stimulate discussion.
John Lyons - Ontario Ministry of Health and Long-Term Care
John was a police officer in the Royal Canadian Mounted Police for 28 years. For 15 years he served in international operations, first as a coordinator for FBI investigations in Canada. During ten years with the Interpol Ottawa National Central Bureau, he was head of the Cultural Property Crime Unit and then Head of the overall Crimes Section. During that time, John was seconded to the Air India Task Force and to a year conducting terriorist/extermist risk assessments. He completed his career in Training Directorate, where he designed and implemented "train the trainers" programs transferring know-how on criminal intelligence and money laundering in Central Europe and Southeast Asia. He coordinated a national initiative that introduced problem-oriented policing and capacity building to centers across Canada. Following his service in the RCMP, he investigated property and casualty insurance claims for the Insurance Crime Prevention Bureau, providing incites into the crime challenges faced by the industry. In 1993, he received the Governor General of Canada Commemorative Medal on the 125th Anniversary of the Government of Canada, "in recognition of significant contribution to compatriots, community and to Canada." John's attention is now drawn to the identification and reduction of identity-based crime, concomitant with fraud controls in automated health care payment systems. He is an ardent practitioner of problem-oriented law and regulatory enforcement, 2nd Generation Crime Prevention through Environment Design (Saville & Cleveland) and problem based learning.
Presenting: ID Crime: Do You Know What To Look For?
This break-out session places the consumer financial crime genre of "identity theft" within the broader framework of all identity-based crimes. On a macro scale, the session points out different types, the weaknesses in our document issuing and screening systems, and how our North American government and business systems are exploited to commit ID-based crimes. On a micro-scale the session recognizes the unlikelihood that identity document handlers are able to discern the genuine from counterfeits. Those successes that occur are generally based on the "intuitive instincts" of handlers with document acumen and listening skills to root out deception. With this in mind, the session provides an introductory level of understanding on foundation and 2nd generation identity documents, as well as inter-related access tokens (e.g. social insurance number driver's license) often mistaken for identity documents.
Ken Froese - President, Association of Certified Forensic Investigators of Canada
Ken Froese, President, Association of Certified Forensic Investigators and Director, LECG, has provided financial investigations and fraud-related services to the public and private sector since 1990. His engagements often include assistance in quantifying losses attributed to the fraud, assisting in preparing insurance claims, tracing and recovering assets, and advising on fraud prevention strategies.
Presenting: Understanding Forensic Investigations
In order to meet the challenges that fraud presents today, an investigator must be able to effectively and efficiently resolve related and sometimes sensitive issues in a timely fashion through various investigative techniques. But just what is a forensic investigation and how does it differ from such other types of reviews? What are the most common, and not so common, perils and pitfalls that you should be aware of and what are the various techniques that the professionals use? This interactive session, using a case study, is designed to be both entertaining as well as informative.
Mark Hartlen - Staff Sergeant, Halifax Regional Police
Staff Sergeant Mark HARTLEN is a graduate of Dalhousie University and has been a police officer in Halifax for the past 20 years. He graduated from Dalhousie University in 1986 with a Bachelor of Arts Major in Sociology and Psychology. Mark has received extensive training in interviewing and interrogation, and is a Certified Forensic Polygraphist and a Certified Hypnotist. Mark has conducted hundreds of criminal interviews ranging from homicide to fraud suspects. Mark has been conducting polygraph examinations since 1995. Mark has lectured on interviewing and interrogation at the Canadian Police College, CCRA, Nova Scotia Department of Justice, Nova Scotia Department of Labour, Nova Scotia Gaming and Alcohol Authority, Department of Natural Resources, Bermuda Police Training Academy and numerous other police agencies and private corporations.
Presenting: Get The Answers You Want - The Right Way
Maureen Ward - Bennett Jones
Maureen Ward is an associate in the Litigation Department and Fraud Law Practice Group at Bennett Jones LLP in Toronto. Maureen practices commercial and fraud litigation and has experience in commercial disputes and commercial arbitration proceedings. Maureen has experience in recovery issues related to fraud, including Mareva injunctions, Anton Piller orders, Norwich Pharmacal orders, tracing, fraudulent conveyances, employee theft, secret commissions, offshore banking and money laundering, restitution orders, disclosure orders and proceeds of crime. Maureen is a member of the Law Society of Upper Canada, the Canadian Bar Association and The Advocates' Society. She is a frequent lecturer on fraud recovery and also lectures at the Ontario Police College. She is co-author of the legal chapter of the Association of Certified Forensic Investigators of Canada Certification Manual.
Presenting: Legal Strategies for Fraud Recovery
The potential inability to recoup fraud losses can be offset at an early stage by utilizing extraordinary common law remedies. The civil remedies that can assist in effective recovery of fraudulently obtained funds include Mareva injunctions, Anton Piller orders and Norwich Pharmacal orders. Maureen will discuss each of these remedies and how they can be incorporated in to a cost-effective fraud litigation strategy. Maureen will also discuss practical issues in detecting and confronting fraud in the health care regime.
Mike Mandel - Hypnotist & Brain Software Speaker
Widely regarded as the world's greatest living hypnotist, Mike Mandel has hypnotized tens of thousands of people throughout Canada, the U.S., Britain and Australia. Drawing from personal experience and research, his "brain software" presentations offer a powerful and enlightening guide to advanced thinking techniques, communication skills and hypnotic language patterns. Mike consults to all levels of government and has trained a wide variety of groups including veterinary surgeons, computer programmers, nurses, social workers, therapists and salespeople. Mike trains
Ontario Provincial Police
Defensive Tactics instructors, security personnel and demonstrated hand to hand combat at the Royal Armouries Museum in Leeds England. Mike Mandel is a self-described "reasonably normal guy with a really weird job". A uniquely qualified communicator, he has a gift for being simultaneously fascinating and hilarious!
Presenting: Brain Software
Psychotherapist, martial arts instructor, and forensic hypnotist Mike Mandel brings you amazing techniques to run your brain more effectively. Communicate with power and influence, eliminate conflict, deal with difficult people and even become more intelligent!
Richard Lussier - Workers' Compensation Board
Richard Lussier served for 20 years in the RCMP. He spent 16 years New Brunswick performing general detachment and highway patrol duties along with 2 years on Major Crime in Moncton and 4 1/2 years on Commercial Crime in Fredericton. He also spent 4 years in Ottawa with the Economic Crime Directorate. During this period in Ottawa, he was also seconded for 1 year with the Department of the Solicitor General of Canada on a research project entitled "Tracing of Illicit Funds - Money Laundering." Mr. Lussier spent 6 years with the Insurance Crime Prevention Bureau conducting investigations on questionable insurance claims on behalf of insurance companies members of the Bureau. He also conducted fire scene examinations to determine the origin and cause of fires, and has been declared by the Provincial Court in New Brunswick as an expert in this field. He has served 5 years with the Workplace Health, Safety and Compensation Commission of New Brunswick as Senior Investigator.
Presenting: Red Flags In Disability
Session description unavailable at time of printing.
Rita Estwick - Canada Post Corporation
Rita Estwick is the Manager, Corporate Security, Risk Management Network with Canada Post Corporation, out of Toronto. Within her 11 years at Canada Post Corporation, Rita has established strategic partnerships with many organizations and industry associations within various industry sectors as it relates to managing crime risk exposures. She is a recognized subject matter expert and addresses groups on a wide range of topics both within the Canadian and international markets. Rita works closely with internal and external clients in the development of best practices to educate and mitigate risk exposures within the distribution channel.
Presenting: Mail Distribution - Internet Crime And Theft of Mail
As a prominent global leader within the supply chain channel, Canada Post Corporation holds a special trust and accountability for the mail it delivers, and, as such, recognizes the importance of working collaboratively with commercial businesses to identify and minimize the various risk exposures associated with distribution. Ms. Estwick will be presenting an overview of the types of exposures associated with the distribution channel and the risk mitigating strategies (including best practices and information-sharing initiatives) which are being implemented to minimize the risks.
Rodney Conoley - Venosan Canada
Rod was born in Murdochville, Quebec and studied business marketing at St. Lawrence College (Cornwall, Ontario) and later graduated from Algonquin College in Ottawa. His business background has spanned over 28 years, associated completely within the Home Health Care industry. His roles have included warehouse management, customer service, sales, sales training and management, marketing and strategic planning. Rod has gained much satisfaction from his years in the Home Health Care sector. Rod is the president and managing director of Venosan Canada. Rod enjoys working with people at all levels of organisations and is a hands-on, results-oriented leader. He has been able to inspire leadership in others and has been a strong proponent of team building, focused on a shared sense of mission. Rod and his wife Bertha have made Ottawa, Ontario their home. They have two beautiful children, Craig who is completing his forth year masters in film at Queens University and a daughter Kayla who is preparing for her university studies in Photo Journalism.
Presenting: Compression Stockings
This presentation will provide some educated insight to compression therapy, including basic physiology as it relates to particular indications and conditions. The role of the physician, and the retail provider, the various compression classes and qualities relative to the indication treated, and made-to-measure garments will be covered. The session will examine the responsibilities of the retail provider and the manufacturer as it relates to billing and processing claims. Catalogues, literature, and manufacturers' suggested retail pricing will be provided.
Sandy Winfield - Assistance Vice President of Operations, World Access
Since joining World Access 4 years ago, Sandy has held various positions including Director of the Contact Centre and Director of Claims. More recently, Sandy became accountable for all the day to day functions as the Assistant Vice President of Operations. Prior to joining World Access, Sandy had over 25 years experience with Manulife Financial including various leadership roles within the Group Business Unit. She has her HIAA and FLMI designations.
Presenting: Out-Of-Country Claims Fraud
What are the key factors to help 'STOP THE BLEEDING' for Out of Country claims? Attendees at this workshop will learn more not only about the importance of Fraud Detection but also the significance of Fraud Prevention. What impact can Relationship Building have on deterring fraud?
Scott Moore - Detective Sergeant, Ontario Provincial Police
Scott Moore has been a member of the Ontario Provincial Police for over 18 years, and is one of the original members of the Health Fraud Investigation Team, which was formed by the OPP 8 years ago. The OPP Heath Fraud Investigation Team is responsible for conducting investigations into frauds against the Ministry of Health and Long-Term Care, as well as working with many other partners in our fight against Health Care Fraud. Scott has conducted fraud investigations in relation to Psychotherapy, Diagnostic Imagery, and Pharmacies, as well as provided advice on many other types of practitioner frauds. Scott currently manages officers in two areas of the Teams' business - User Fraud Investigations and Drug Diversion Investigations. Scott is fully trained as a Forensic Computer Analyst. He has experience in forensic analyses of PC and Macintosh systems, e-mail threats, and Internet investigations. Scott has spent over 14 years in criminal investigations, and has a background in fraud, homicide, drugs, surveillance and undercover operations. Scott is on the Executive Board of the CHCAA. In the past, Scott has presented several times at the CHCAA Annual Conference, as well as at the 2002 Toronto Police Service Annual Fraud Conference. Scott also presented last year (2005) at the 3rd Annual International Conference on Identity Theft.
Presenting: Drugs Or Money - It's Walking Out The Door!
Whether you belong to a private or a public agency, you WILL pay claims to pharmacies. This session will provide an overview of some of the areas of abuse found during eight years of investigating Health Care Fraud on behalf of the Province of Ontario's health care system. Scams, collusion, diversion or organized groups - whether it's drugs or money that is going out the door, you're paying for it!
Terry Scott - Sergeant, Royal Canadian Mounted Police
Sergeant Scott is a member of the Royal Canadian Mounted Police with thirty-three and a half years' service and is presently stationed in St. John's, Newfoundland and Labrador, as the Undercover Coordinator for the Province. Sergeant Scott has twenty-seven years' experience in drug enforcement. He has been an Undercover Operator since 1978 and is still active in that area, having conducted investigations in all provinces across Canada.
Presenting: Oxycontin - Abuse And Investigation
The subject I intend to speak on at the CHCAA Conference will relate to the undercover operation that was put in place to infiltrate a well-known Medical Doctor in St. John's, NL, who was suspected of illegally supplying oxycontin and other drugs to several patients and the commission of other Criminal Code offences involving patients. I would like to point out that some parts of this investigation involved equipment and techniques that are very sensitive and that cannot be disclosed.
Tom Blackwell - National Post
Tom Blackwell has been a newspaper journalist for 20 years, working everywhere from one of Canada's smallest dailies to the Canadian Press news service and the country's newest national paper. He has extensive experience covering crime - including the Colin Thatcher murder case and the Bernardo trial - and politics, including the first years of the Mike Harris governent in Ontario. Blackwell has been at the National Post for five years, and has been the newspaper's health care reporter for the last two years.
Presenting: Fraud In Health Care: An Outsider's Perspective
Forget about the experts and the insiders for a moment. What does an informed outsider think about health-care fraud, its threat to Canadians and how to combat it? This presentation will review a five-part series on health fraud in the National Post, and offer a journalist's big-picture perspective on the field's key issues. Health fraud should be a concern to all Canadians, not just insurance company investigators and a few police fraud detectives, argues Post reporter Tom Blackwell.
William Hiltz - Forensic Consultant, Prosperident
William R. (Bill) Hiltz is a senior advisor with prosperident, a Halifax-based management consulting firm with clients from across Canada and the US specializing in providing assistance in tax planning, practice transition, dental economics, fraud prevention and detection to dentists and dental practices. Bill brings over 15 years experience in practice management consulting to prosperident. Prior to joining the firm, Bill was a senior administrative manager for a public post secondary educational institution and headed his own consulting firm. Bill serves as an advisory board member for the Order of Privacy Officers and is a frequent lecturer; particularly in the areas of dental fraud, records security and confidentiality. Bill holds a diploma in applied technology from the Marine Institute, a Bachelor of Science (AdvMaj) and Masters of Business Administration from Dalhousie. In addition to these degrees, Bill is a Certified Engineering Technologist with in-depth experience with computer technology.
Presenting: Dental Practice: Are YOU Getting Cleaned?
The American Dental Association reports that 1 in 3 dentists will be embezzled at during their career. Media reports of dentists losing over $100,000 to employee theft are not uncommon. Our own case files show an average loss to the dentist of $50,000 before fraud is detected and stopped. The focus of this course will be to examine actual methods used by fraudsters, as taken from our case files. Mr. Hiltz's experience in dealing with these and other cases of fraud will provide a more in-depth analysis of the situation than generally available.