Meeting/Event Information

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November 09, 2011

November Meeting
November 09, 2011
7:30 AM - 11:00 AM
The Radisson Hotel Roseville
2540 North Cleveland Avenue
Roseville, MN 55113
http://www.radisson.com/roseville-hotel-mn-55113/mnroserd?s_cid=se.ggl.rad_cmp15
Updated speakers set for the first networking and training opportunity of our 2011-12 year!

$30.00 TCCCFE Member Attendance for November 9, 2011
$25.00 Earlybird rate before November 3

$40.00 TCCCFE non-member attendance for November 9, 2011
$35.00 Earlybird rate before November 3

The first networking and training opportunity of our 2011-12 year will be held Wednesday, November 9, 2011, at The Radisson Hotel Roseville.  Our scheduled speakers are Matthew H. Berls and Kelly Giancristoforo from the Special Investigations Unit for United Healthcare’s Public and Senior Market Group, and a team from the Minnesota Attorney General Medicaid Fraud Control Unit.  Immediately following the general meeting the Board of Directors will hold the quarterly business meeting.

Mr. Berls and Ms. Giancristoforo will be sharing their insights on emerging trends and fraud schemes within the Medicare/Pharmaceuticals arena.  Their presentation will examine recent Part D trends and schemes including the West Hollywood Area Project, overutilization, diversion and counterfeit drugs. Attendees will gain investigative ideas through case examples and industry experience from health care fraud specialists focused on Part D investigations, including the follwing trends and schemes:

  • Billing several payers for the same prescription
  • Prescription drug splitting or shorting
  • Forging or altering prescriptions
  • Dispensing expired or adulterated prescription drugs
  • Incorrectly billing secondary payers
  • Billing for nonexistent prescriptions
  • Billing for brand-name when generics are dispensed
  • Script Mills
  • DEA number or prescription pads are stolen
  • Using insurance to obtain prescriptions for others
  • Selling prescriptions
  • Unusual activity or a higher than normal percentage of Part D EOBs

Matt Berls is currently a Senior Investigator at UnitedHealthcare Medicare & Retirement, Public & Senior Market Group – Special Investigations Unit.  In his role, Mr. Berls’ primary responsibilities pertain specifically to all aspects of Medicare Part C & Part D investigations.  Prior to joining UnitedHealthcare, Mr. Berls was a Senior Investigative Analyst for Health Net’s Northeast Special Investigations Unit, where he served as one of the lead investigators for numerous Medicare Part C Infusion Therapy Schemes and the primary investigator for the Medicare Part D West Area Hollywood Project – both resulting in high dollar recoveries and/or criminal convictions.   Mr. Berls has both a Bachelor of Arts and Masters Degree in Political Science with a Pre-Law Collateral and a specialization in International Relations, respectively.  In addition, Mr. Berls has completed basic and advanced seminars on “The Reid Technique of Interviewing and Interrogation.”

Kelly Giancristoforo is the Director of the Special Investigations Unit for United Healthcare’s Public & Senior Market Group.  In that role she has oversight of the Medicare investigative functions within the SIU.  Kelly, who is a CFE, has a Bachelor of Arts Degree specializing in Criminal Justice and Legal Studies.  Kelly has experience with healthcare fraud investigations in both public and private capacities, specializing in data analytics and comprehensive investigative plans.  Kelly has served on several committees related to detection and prevention of infusion therapy schemes and served as manager and one of the lead investigators for UnitedHealth Group for numerous Medicare Part C Infusion Therapy cases.

The team from the Minnesota Attorney General Medicaid Fraud Control Unit is scheduled to include two attorneys and an investigator, and they will provide information on the topics of:

  • Medicaid Fraud;
  • Financial fraud and vulnerable adults; and
  • Investigation techniques related to Medicaid Fraud and vulnerable adults.

Attendance at the general session may be used to fulfill three hours of fraud related CPE.  MN POST Credits Pending.

Our planned meeting schedule will be as follows: 

7:30 – 8:00        Registration, Networking and Breakfast Buffet

8:00 – 8:10        Announcements

8:10 – 9:40        Minnesota Attorney General Medicaid Fraud Control Unit

9:40 – 10:00      Break and Networking

10:00 – 11:00    Mr. Berls and Ms. Giancristoforo

11:00                   Adjourn general meeting

11:00 – 12:00    Board of Directors business meeting

To qualify for advance registration pricing, registration must be completed on-line no later than 5:00 p.m. on Thursday, November 3, 2011. 

As before, payment by cash or check is accepted at the meeting.  Guests are always welcome, and we are usually able to accommodate late registrations and walk-ins.  Attendees will be eligible to register for our door prize drawing ($25 gift card). 

Please note, the remaining meeting dates for the 2011-12 year are currently scheduled for February 8, 2011, May 9, 2012, and August 8, 2012.

If you have any questions, please don’t hesitate to contact either Sue Meyer at [email protected] or Marc Courey at [email protected].

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