Events Calendar

Fraud and Abuse Workgroup Meeting 12-13-2010

2010-12-13, 9:00am to 12:00pm, 630 Davis Dr., Suite 100 Morrisville, NC 27560

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This event is related to the Health Reform: Fraud and Abuse Workgroup Task Force.


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  • Agenda
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    9:00-9:15 Welcome and Introductions
    Albert P Koehler, Deputy Commissioner/Director
    Criminal Investigations Division
    NC Department of Insurance

    Tara Larson, Chief Clinical Operations Officer
    Division of Medical Assistance

    9:15-9:30 Current Status of Gap Analysis
    Tracy Hayes, Assistant Attorney General
    NC Department of Justice

    9:30-11:30 Workgroup discussion
    Status of recommendations from last meeting: development of legislation
    • Identification of high risk providers
    • Compliance programs
    • Automatic communication – triggers, referrals, quarterly meetings – between insurers, provider boards, provider associations
    • Criminal background checks

    Billing Agents (Presenter: Rose Shattuck)
    • What defines a billing agent?
    • What is the gap in education on ACA requirements for billing agents? Who’s providing this education?
    • What rules or legislation do we need to develop?

    How does the public system impact private payors?
    • Who should be the “responsible parties” for coordinating public and private payors?
    • What rules or legislation do we need to develop?

    County DSS recipient/fraud
    • What education needs to be provided to the public, and who should provide it?
    • What rules or legislation do we need to develop?

    Legislative Proposal Outline

    11:30-11:45 Plans for next meeting

    11:45-12:00 Public comment period

    Presentations and Handouts