dear!friends!and!colleagues:!it-mis.com/easternclaims/pdfs/ecc_2016_invitation.pdfpage2!!...

Dear Friends and Colleagues: As the Conference Chair, it is my pleasure to welcome you to the 2016 Eastern Claims Conference in New York City. Our goal is to provide you with a positive and fulfilling learning experience. The 2016 agenda is designed to provide attendees with the tools, strategies, best practices and contribute to and lead positive change within their organizations. Mark Whitacre, Ph.D., our keynote speaker is considered the highest-‐ranked executive of any Fortune 500 company to become a whistleblower in U.S. history. Mark was the inspiration of the major motion picture "The Informant," starring Matt Damon as Mark Whitacre, and the 2010 Discovery Channel documentary ‘Undercover.” Our speakers representing the insurance industry will present and discuss the latest topics from their area of expertise including: accidental death and dismemberment, life, medical, legal and fraud issues. These panels and workshops were designed to assist you in your personal growth as an insurance professional. This is an excellent opportunity for you to meet with other insurance professionals, increase your claims knowledge and sharpen your investigation skills. Most importantly, it is an opportunity to come together to reflect and to share. We continue to offer continuing education credits for the following disciplines: fraud, legal, disability, medical and dental. Don’t miss the “Magical Entertainment” during the Monday evening Hospitality Reception. Come and see our interactive performer performing incredible sleight of hand and mind reading effects. You won’t believe your eyes! Before I close, I’d like to thank each of you for considering to attend our conference. The ECC would not be possible without our valued attendees, speakers, sponsors, exhibitors and the ECC staff who volunteer their time, resources and expertise. We could not accomplish what we do without your support. Throughout the conference, I ask that you stay engaged and provide us with suggestions on the feedback cards to help us shape the future of the ECC. Sincerely, Jennifer Cobb, CFE, FCLS, ALHC Conference Chairperson, Eastern Claims Conference

2016 Eastern Claims Conference The Waldorf=Astoria Hotel

New York, New York ECC – 2016

SUNDAY, MARCH 13, 2016

REGISTRATION 1:30 p.m. – 6:30 p.m. (North Foyer-‐18th Floor) MEET AND GREET (First time attendees) 4:00 p.m. – 5:00 p.m. (18th Floor) HOSPITALITY RECEPTION 5:00 p.m. – 6:30 p.m. (Starlight Roof) Only Registered Attendees and Pre-‐registered Guests will be admitted to the Hospitality Receptions

MONDAY, MARCH 14, 2016 REGISTRATION 7:30 a.m. – 3:30 p.m. EXHIBITORS’ RECEPTION 8:00 a.m. – 9:00 a.m. Palm Room A light breakfast buffet will be available Starlight Roof Pastries and coffee will be available. WELCOME ADDRESS 9:00 a.m. – 9:15 a.m. Starlight Roof Donna A. Conticchio, ALHC, HIA, ACS AIG Benefit Solutions, Neptune, NJ President, Eastern Claims Conference Board INTRODUCTION Christine Prutting AXIS Accident & Health, Princeton, NJ Chair, Program Committee KEYNOTE ADDRESS 9:15 a.m. – 9:45 a.m. Mark Whitacre, Ph.D. Cypress Systems, Inc., Florence, KY The Informant – When Good Leaders Lose Their Way

Mark Whitacre is an Ivy League Ph.D. and is considered the highest-‐ranked executive of any Fortune 500 company to become a whistleblower in U.S. history, responsible for uncovering the ADM (Archer Daniels Midland) price-‐fixing scandal in the early 1990s. Mark Whitacre worked undercover with the FBI for 3 years, wearing a wire every day and traveling the globe in one of the largest white-‐collar crime cases in US history. After his undercover tenure was completed, Mark went to federal prison for 8 1/2 years for a white-‐collar crime that occurred during his undercover tenure. His story was the inspiration of the major motion picture "The Informant," starring Matt Damon as Mark Whitacre, and the 2010 Discovery Channel documentary “Undercover” and the book "Mark Whitacre Against all Odds," refer to the website www.markwhitacre.com. His inspirational story is not only about ethics

and compliance, but also about hope, redemption and second chances and a family overcoming extreme adversity, against all odds. Today, the four FBI agents involved with Whitacre's case tout him publicly as a "national hero" for his substantial assistance with one of the most important white-‐collar cases in history. And Douglas Burris, chief of U.S. Federal Probation in the Eastern District of Missouri, has stated publicly, "The story about Mark Whitacre's redemption and second chance is one of the most inspirational stories of our time."

MONDAY, MARCH 14, 2016 CONCURRENT SESSIONS 10:00 a.m. – 11:15 a.m. Panel 1. Hmm…Ask The Panel Richard Marquez, CFE, Diligence International Group, Carrollton, TX Kevin Glasgow, FLMI, Munich Re, Atlanta, GA Marlon Fearon, Swiss Re, Armonk, NY John Patton, FLMI, FLHC, CLU, CHFC, AALU, FCLA, AIRC, ACS, Farmers New World Life, Mercer Island, WA This will be a unique session in that the audience will decide the content of the session – This will be a panel lead discussion on topics raised by the audience. The Attendees will be asked for questions during the session, and the panel will try to answer the questions or facilitate a group discussion. Attendees will also be given the opportunity ahead of the session to submit questions and topics. No topic is too basic or complex, so bring your questions and get the benefit of the thoughts and opinions of the industry experts on the panel. Also, be prepared to share your views as well since you might be an expert to a question asked. Panel 2A. Social Security – Past, Present and Future Barbara Mountain, Doherty, Cella, Keane LLP., Beverly, MA Christopher Doherty, Doherty, Cella, Keane LLP., Beverly, MA This session will provide a history of Social Security; why it was created, why it was funded as a pay as you go system, and, it's future solvency. We will include a discussion of the current political climate and the potential impact on SS Disability Program and the possible impact on insurers and claimants. This is a must see presentation as it literally affects each and every one of us and it is a hot button issue in the 2016 presidential election. Panel 2B. Life…Down Under Effie Sofatzis, Munich Re Australia, Sydney, Australia This session will provide attendees with a comprehensive review of the Australian Life Insurance market, with a particular focus on Retail Disability Income Products and Claims management. Topics include:

• Australian Market overview

• Products in Australia including an illustrative comparison to the US market • Recent Australian claims experience and causes • Disputes and legal environment

• Learning from our experience (and yours) • What next? Panel 3. Real Life Ethics Message: To Tell or Not To Tell Mark Whitacre, Ph.D., Cypress Systems, Inc., Florence, KY Join us for a very interactive group discussion about how one would handle three real life ethical dilemmas.

Here is your opportunity to learn more about Mr. Whitacre’s work and the impact of his undercover activities on the country. This informative and bound to be interesting session covers: • Real-‐life lessons in personal and business ethics accountability • The danger of making critical decisions in isolation Panel 4. When Good Rescissions Go Bad: Advanced Issues in the Rescission of Life and Disability Policies D. Larry Kristinik, Esq., Nelson Mullins Riley & Scarborough LLP, Columbia, SC Maureen M. Middleton, Esq., Primerica Life Insurance Company, Duluth, GA

When can a subtle entry on a scriptcheck report undermine a rescission? In what situation is rescission still available even when the agent was told of a concealed medical condition? How can the door be left open for a challenge to a rescission even when the premium refund check is cashed? This program addresses these and other advanced issues arising when misrepresentations are made in applications for life and disability policies. The speakers will work through a number of different scenarios that would challenge even the most seasoned claims manager. Panel 5. Introduction to Data Mining Healthcare Fraud Douglas Rahden, CPMA, Cigna, Chicago, IL Sean Petree, AHFI, Cigna, Hartford, CT

Applying analytics and data mining for fraud detection and to launch actionable investigations can present a challenge for even seasoned investigators or analysts. This session will share some basic, general data mining techniques as well as methods specific to certain medical specialties and dental procedures. A basic overview of available tools and resources will be discussed and an analytic healthcare fraud case study will be presented.

MONDAY, MARCH 14, 2016

EXHIBITORS’ RECEPTION 11:15 a.m. – 12:00 p.m. Starlight Roof & Palm Room LUNCH 12:00 p.m. – 1:00 p.m. Starlight Roof


CONCURRENT SESSIONS 1:15 p.m. – 2:30 p.m. Panel 6. The Difference Between Medical Examiner and Coroner Elliot M. Gross, M.D., Former Chief Medical Examiner, New York, NY Coroners and Medical Examiners both deal with death, and the two titles are often used interchangeably as a result. This usage is technically incorrect, since the job descriptions are actually very different. Dr. Gross will provide information on the differences between a Medical Examiner (ME) and Coroner, their backgrounds and biases, and how to best approach them for information. Panel 7A. In The Hot Seat Steve Allen, FLHC, ACS, FLMI, Trustmark Insurance, Worcester, MA Philip M. Howe, Esq., Lecomte, Emanuelson & Doyle, Quincy, MA Robert Hess, Esq., Hinshaw & Culbertson LLP., Irvine, CA The likelihood of an adverse claim decision going to trial depends on multiple issues. However, when the result of a claim decision does get to trial, what could happen? What is it like to be in the witness chair? What tactics might the plaintiff's counsel take? What significance do verbal/non-‐verbal responses have to the line of questioning? Most importantly, the "average" claim staffer would learn the importance of claim documentation from a different (and potentially painful) perspective. Panel 7B. Claim Analytics Ian Bridgman, The Claim Lab, Sherborn, MA Data analytics is changing the way our lives work, the decisions we make, and how we behave. How can we best apply these techniques to claims management? To be successful we must ensure that the analytical information we provide is understandable and actionable. We will look at examples of where analytical tools have been used successfully, and what these claims operations are doing next to enhance its benefits. We will also look at ongoing research that will move this exciting topic forward. Panel 8. Real Life Ethical Dilemmas – An Interactive Group Workshop Mark Whitacre, PH.D., Cypress Systems, Inc., Florence, KY Join us for a very interactive group discussion about how one would handle three real life ethical dilemmas.

This PM session is the 2nd breakout session of Mark Whitacre, who is the keynote speaker during the same morning. Drawing from his unique history, Mark provides one-‐of-‐a-‐kind insight into corporate ethics, corporate greed, and the warning signs of a flawed corporate leadership. This informative and bound to be interesting session covers:

• Real-‐life lessons in personal and business ethics accountability • The danger of making critical decisions in isolation

Panel 9. Trends in Life & Accident Insurance – Domestic and Abroad Adrienne C. Publicover, Esq., Wilson, Elser, Moskowitz, Edelman & Dicker LLP, San Francisco, CA Kathy Owens, AIC, AIS, Crosswalk Claims Management, LLC, Farmington, CT You can't make these facts up!! If you want to learn about the most recent trends in life and accident claims, gleaned from case law and real world experience, then please join attorney Adrienne Publicover and experienced Accident & Special Risks Claim Manager Mark McDougall for this interesting and informative session. Panel 10. Orthopedic Examination Findings…Red Flags to Look For In A Medical Record Review Dr. Tom Jones, DC, CES, CCRD, CSCS Independent Consultant, Toms River, NJ Have you ever wondered if the medical file you are looking at is credible and appropriate treatment is being rendered or if it is filled with embellishment or even fabrication? Orthopedic testing is an essential part of the medical process when treating the neuromusculoskeletal system. But what do all those negative and positive results really mean? Dr. Jones will explain the fundamentals of reviewing a medical file and how to decipher and use orthopedic testing results to your advantage. He will discuss a forensic approach of interpreting orthopedic exam results and correlating them to other areas of the medical file which reveal inconsistencies. This information will give you insight as to the relevancy of chiropractic, orthopedic and/or physical therapy treatment.


CONCURRENT SESSIONS 2:45 p.m. – 4:00 p.m. Panel 11A. Group Life Claims…The Next Millennium Rick Denman, FLMI, ALHC, ACS, Munich Re, Atlanta, GA Ross Stedman, Securian Financial Group, St. Paul, MN When you think of evolving industries, what comes to mind? Technology? Medicine? How about Group Life Insurance? We are likely facing a significant number of impactful changes from external and internal forces in the next 5-‐10 years. Changes in technology alone will drive new ways of filing claims and communicating with policyholders and beneficiaries. Newer offerings such as concierge level services may become the norm as group policyholders look for enhanced services for their employees. What policy wording will need to be changed due to new legal and regulatory rulings? Internally, how and where will claim staff do their jobs? Will millennials in our operations drive new needs for hiring, training, and quality programs? We'll share our ideas on these and more; come join us for what we hope is a highly interactive discussion on the future of our business! Panel 11B. Psychosocial Function of Claims Management Les Kertay, PhD., Behavioral Medical Interventions, Edina, MN William Hittler, Esq., Nilan Johnson Lewis PA, Minneapolis, MN What are the key aspects of the psychosocial function of life/disability claims management? Every claim has such functions. Our goal is to identify common, sometimes subtle, behaviors that arise in inherently stressful and often confrontational situations particularly when a claim has been denied.

Some real world examples will be discussed from cases illustrating the importance of these behavioral scenarios as they affect the integrity of the claims review process and the daily relationships between the company and its insureds. The panel will also discuss effective ways to communicate with claimants and properly evaluate each claim on its merits. Panel 12. On Solid Ground with Your Expert’s Opinions Lori Cohen, PhD, Independent Claim Consultants Network, LLP, Haydenville, MA Kimberly Tomaselli, CPA, FLMI, ALHC, ARA, Munich Re, Atlanta, GA David Lovejoy, Psy.D., Mass Mutual Financial Group, Springfield, MA When it comes to utilizing expert opinions, be sure you're in the game. As a valuable participant in a Peer Reviewer interview, or as a sophisticated consumer of your expert's data, your role as claims examiner is integral to the Peer Review process. Through role play exercises this presentation focuses on behind-‐the-‐scenes interview techniques and the value of the perspective and questions of the claims examiner. Panel 13. Customer Service – What if It Was You? Christine Prutting, AXIS Insurance, Princeton, NJ Sophia Aikman, Munich Re, Atlanta, GA No amount of software can compensate for bad customer service. Are you so sure that you are providing the best service that you are willing to put your name on it? If not, this is the session to attend to learn the keys to improving your skills and banishing bad habits. Come ready to share your own experiences and learn how to break from the script. Panel 14. Cutting Edge AD&D – What’s an Accident These Days? Gary Schuman, Esq., Combined Insurance/ An ACE Group Company, Chicago, IL E. Ford Stephens, Esq., Christian & Barton, LLP, Richmond, VA This year, our presenters, experienced in-‐house and outside lawyers, will focus on some of the recent cases and current trends in AD&D. What are courts considering to be accidents and why? When do exclusions apply and why have some courts rejected them? Does the application of ERISA have an effect on claim outcomes? Come ready to share your own claim experiences and join in what promises to be an interesting discussion. Panel 15. Dental Schemes and Scams – Take a Bite Out of Fraud Phyllis Heller, AHFI, Anthem, Iselin, NJ This session will review dental fraud, waste and abuse by both unscrupulous providers and members including: improper billing, common red flag indicators and examination of various coding schemes. Useful tips will be provided on how to conduct data mining for suspect dental services.

HOSPITALITY RECEPTION 5:00 p.m. – 6:30 p.m. Starlight Roof Magical Night…Up Close and Personal

Come see some amazing magic performed right in front of you. Our interactive performer Robert McEntee, will stroll from group to group performing incredible sleight of hand and mind reading effects. You won’t believe your eyes! Don’t miss someone attempt to read another attendee’s mind!

Only Registered Attendees and Pre-‐registered Guests will be admitted to the Hospitality Receptions

TUESDAY, MARCH 15, 2016

REGISTRATION 8:00 a.m. – 1:55 p.m. North Foyer – 18th Floor EXHIBITORS’ RECEPTION 8:00 a.m. – 9:00 a.m. Starlight Roof & Palm Room Pastries and coffee will be available

TUESDAY, MARCH 15, 2016 CONCURRENT SESSIONS 9:00 a.m. – 10:15 a.m. Panel 16. Marijuana in the Workplace – What Can an Employer Do? Whitley Crow, Conspire!, Colorado Springs, CO William D. Nelson, Esq., Lewis, Roca, Rothgerber, LLP, Colorado Springs, CO Medical marijuana is "legal" in twenty-‐three states and the District of Columbia. Recreational marijuana is "legal" in four states and the District of Columbia. Like it or not, marijuana has become a common workplace issue creating new and expanding challenges for employers. This session will provide an overview of the medical and recreational marijuana laws in the various states, discuss what employers can and cannot do through workplace policies and procedures, discuss cases raising constitutional challenges to state marijuana laws, provide an overview to workplace drug testing, including the methods of testing, what is and is not permissible and what constitutes impairment. Panel 17. The Great Financial Debate! John Hoffman, CPA, CFF, CITF, Nawrocki Smith, LLP, Melville, NY P. Dimitris Bantileskas, CPA, CFF, CITP, CFE, Nawrocki Smith, LLP, Melville, NY Ernest Patrick Smith, CPA, CVA, CFE, CFF, ABV, Nawrocki Smith, LLP, Melville, NY John M. Spatola, CPA, ABV, CFF, CVA, CFE, Nawrocki Smith, LLP, Melville, NY Come hear the panelists share their platforms and positions on financial disability claim scenarios. They will also cover methods and approaches to broader financial topics relevant to the industry. There will be opportunities to question the candidates on issues important to you and your colleagues in a town hall format. Our experienced moderator will lead you through the only debate that really matters in 2016!

Panel 18. Fighting Fraud With Advanced and Predictive Analytics Douglas Rahden, CPMA, Cigna, Chicago, IL Jason DiNovi, CPMA, Cigna, Chicago, IL Analysts and data scientists are giving their organizations an edge by applying predictive analytics on big data to fight fraud. Learn how to mitigate financial risk while also helping to protect patients from harm in this primer for advanced analysis. Attendees will learn about advanced and predictive analytic methods including sampling, correlation, regression and modeling as well as supporting tools including RAT-‐STATS, SQL, R, SAS, and SPSS. Panel 19. Sorry, I Spent It – The Effect of State Anti-‐Subrogation Laws on the Administration of Claims for Benefits Under ERISA Governed Plans Matthew P. Mazzola, Esq., Sedgwick LLP., New York, NY Almost universally, ERISA-‐governed plans contain subrogation and equitable lien provisions to require the return of plan benefits to preserve plan assets for the benefit of the enrollees. Recently, states have enacted laws designed to frustrate the return of the plan assets referred to as anti-‐subrogation laws. We will discuss recent enforcement attempts to recover plan benefits, the effect of state anti-‐subrogation laws, the trends in case law and ways to combat these state laws interfering with the administration of plans. Panel 20. Home Alone V…The Unreleased Sequel Ronald S. Chillemi, Esquire, Partner, Robins Kaplan LLP, New York More and more families are choosing to keep their ill loved ones at home to care for them. As a result there has been a dramatic increase in people receiving a multitude of home care services. With home care claims rising we have also seen a rise in home care claims fraud. Establishment of home care agencies are also on the rise. Unfortunately, rules and regulations around home care services have not evolved quite as fast as the industry has grown. The Centers for Medicaid and Medicare Services have determined that Home Health Agencies are in a high risk category for fraud. In this session we will learn about home care services schemes as well as hear about a home care fraud case that has resulted in arrests, and numerous State prison sentences for health care claims fraud. We will also provide an overview of the NICB and its partnership with law enforcement.


CONCURRENT SESSIONS 10:30 a.m. – 11:45 a.m. Panel 21. The Life Insurance Industry: Trends & Challenges James Swinton, FALU, FLMI, Munich Re, Atlanta, GA Curtis McAdams, ALHC, Munich Re, Atlanta, GA We will take a look at the latest industry trends for Life claims and discuss some of the trends that may affect claims and their best practices. Our focus will include claim patterns/trends involving various causes of death, face amount and age bands, mature ages (ages 70 and up), and early duration periods. We will include a discussion of changes in Marketing, Underwriting or other departments that may affect the adjudication of life claims.

Panel 22A. Bad Faith Litigation Richard M Sabetta, Risk Navigation Group, LLC, Morristown, NJ Bad Faith litigation has been prevalent and increasing for more than a decade, and now new legal threats to the exclusive remedy domain of Workers' Compensation makes its intersection with Group Health, particularly short term disability benefits, an area of vulnerability for insurers. This session will outline those vulnerabilities and discuss tactics and best practices that help mitigate and avoid bad faith allegations and exposure.

Panel 22B. Legislative Update (ERISA) Steve Clayburn, American Council of Life Insurers, Washington, DC Stan Kulesa, Symetra, Enfield, CT Insurance is a state-‐regulated business, but elements of the federal government also have a substantial (and growing) impact. This session will provide insight into assorted examples of proposed legislation and rule changes pending before various legislative and/or regulatory entities. The speakers will heighten awareness around how these changes could impact such significant issues as ERISA claim regulations, mental/nervous parity issues with disability claims, threats to Social Security offsetting practices, unisex pricing, etc. Panel 23. Writing Effective Investigation Reports Angela Reddock-‐Wright, Esq., Reddock Law Group, Los Angeles, CA The ability to write clear, concise, accurate and informative investigation reports is a valuable skill for investigators of all kinds. A well-‐written investigation report provides a complete picture of the incident or event and leaves no questions unanswered about who did what, when and how and is written in language that can be understood by anyone reading it. During this session, Reddock-‐Wright will outline the elements of effective investigation report writing. Among other things, we will discuss the following:

• How conducting an investigation is the key to writing a great investigation report • What information should and should not be included in an investigation report • Formats to use for investigation reports • Language to use in an investigation report • Why attention to detail is so important • Tying together the facts and evidence in your final investigation report • The importance of proofreading • The role of opinion and credibility assessment in an investigation report Panel 24. Health Care Fraud: Litigation Michelle J. d’Arcambal, Esq., d’Arcambal Ousley & Cuyler Burk, LLP., New York, NY Heather Erickson, Sanchez, Daniels & Hoffman LLP, Chicago, IL Michael J. Stephano, UnitedHealthcare, Kingston, NY

Insurance fraud remains an ever increasing issue for insurers. This session will address the many ways that insurers, their customers and members, and state and federal authorities have been attempting to curb fraud in the healthcare industry. Panel 25. Investigating and Prosecuting Kickback Schemes Jacob T. Elberg, Esq., Department of Justice; U.S. Attorney’s Office, District of New Jersey, Newark, NJ Terri DiGorgio, National Insurance Crime Bureau, Edison, NJ Over the past 4 years, the U.S. Attorney's Office has convicted more than 60 doctors and other individuals for their roles in healthcare bribery schemes, leading to significant terms of imprisonment, forfeiture of more than $10 million, and the dismantling of numerous organizations engaged in paying bribes to health care providers. The session will detail the investigation and prosecution of one recent kickback case prosecuted by the Office, and will discuss how coordination between law enforcement and private insurers can aid in the detection and prosecution of illegal kickback schemes.


EXHIBITORS’ RECEPTION 11:45 a.m. – 12:30 p.m. Starlight Roof & Palm Room LUNCH 12:30 p.m. – 1:30 p.m. Starlight Roof LUNCHEON SPEAKER Erin Worthington, CFE, FLMI, FLHC Allstate Insurance Company President, International Claim Association

TUESDAY, MARCH 15, 2016 CONCURRENT SESSIONS 1:45 p.m. – 3:00 p.m. Panel 26A. Claim File Documentation and Preparing for Depositions Amy Atkinson, Esq., Munich Re, Atlanta, GA Kim Houston, ALHC, ACS, AIAA, Munich Re, Atlanta, GA An interactive presentation discussing industry best practices in the documentation of a claim file and preparation of the claims professional for deposition on litigated claims. Panel 26B. Navigating the Ins and Outs of Claim Administration Michele Skafidas, Sun Life, Portsmouth, NH Diana Thulin, Swiss Re, Armonk, NY Katherine Callaghan, CEBS, MetLife Americas, New York, NY A discussion of best practices around administrative issues that arise during the claim adjudication process for both life and disability. For example, how would you handle claims on undocumented workers, premium refunds for billing errors, and proofs for actively at work? We will share feedback based on a survey of your colleagues and look forward to a lively dialogue.

Panel 27. Chronic Pain: What, Why, How, What YOU Can Do Michael Lacroix, PH.D., Aetna Life insurance Company, Sarasota, FL This presentation reviews what we know about chronic (as distinct from acute) pain, focusing on the “Gate Theory,” which is now the accepted explanation for chronic pain. We discuss co-‐morbidities and explore the various avenues to treatment, including medication, surgery, the “pain clinic” approach, and cognitive-‐behavioral strategies. We conclude with a number of useful take-‐aways, including early identification of red flags, options for prevention, and how to dialog about chronic pain with both physicians and claimants. Panel 28. Speed to Detection John Standish, Infinilytics, Inc., Fremont, CA “Speed to Detection” is a strategic concept about identifying the hidden fraud in insurance claims, and government social services programs. Our current methodology of “pay-‐and-‐chase” (i.e., pay the claim and, or bill, and then investigate) to combat fraud is not working. The incidence of insurance fraud is increasing in the United States. Government programs which provide health and medical services are losing millions of dollars every day to organized criminal enterprises, and these enterprises are hiding in plain sight. This presentation will cover trends and current issues in the collection of data, how advanced analytics can make your business process more efficient and responsive to your customers and stakeholders, best practices for investigations, and how social media can be used to identify emerging trends. You will learn how the collection of data, advanced analytics, and best practices for investigations are the key components for successful anti-‐fraud efforts. Government and financial industry executives, prosecutors, attorneys, insurance claim personnel, SIU investigators and managers, law enforcement, and private investigators will gain important information on current trends, issues, and solutions for their anti-‐fraud programs. Panel 29. Hot Topics in ERISA Disability Law Sherril Colombo, Littler Mendelson, Miami, FL Rick Lodi, Cigna, Pittsburgh, PA This session will provide insights and discuss trends in group disability claims and litigation on:

• survillance as an investigative tool; • vocational and transferrable skills assessments; • identification of mental health claims versus those with only a mental health

component; • treating physicians versus peer reviews; and • denials of long-‐term disability claims long after approval of payments under the same policy

definition.

Panel 30. Dissecting Medical & Dental Records Karen Weintraub, MA, AHFI, CPC-‐P, CPMA, Healthcare Fraud Shield, Chesterfield, MO Phyllis Heller, AHFI, Anthem, Iselin, NJ

This session will walk attendees through the art of dissecting a medical record and dental records. Many investigators without clinical backgrounds are hesitant to review records. Conversely, many clinical staff may not be trained to focus on potential fraud indicators. This session will walk through various aspects of medical records from required information, cloning and how to examine dental records for patterns of fraud and more.

Notes

• The attendee registration fee includes admission to the Hospitality Receptions. However, if you bring a guest (a colleague or spouse), a $200 fee is payable for your first Pre-‐registered Guest wishing to attend the receptions. The fee covers both receptions. A $150 fee is payable for each Additional Guest, per event.

• If you have special needs, please contact Arlene Walsh at 718 497 7886 or [email protected].

• Business dress is encouraged.

• There will be a $50 late fee added to registrations received after January 31, 2016.

• There will be no refunds for cancellations received after January 31, 2016.

THE FEDERAL TAX ID NUMBER FOR THE ECC IS 20-‐8 483688

Attendee Registration Fees for 2016

2 days with lunch $625 2 days without lunch $500 1 day with lunch $425 1 day without lunch $350 First Pre-‐registered guest $200 Each additional guest (per event) $150 Late fee after January 31, 2016 $ 50

Waldorf = Astoria 301 Park Avenue

New York, NY 10022-‐6897 1 877 GROUP WA (1 877 476 8792)

Hotel Rates for 2016 (Use Hotel Code ECC)

Accommodations Single/Double Deluxe Queen $259 King Bed & Double/Double Superior Room $259 King Bed Luxury Room $359

• All Room rates are subject to state and local taxes, currently 14.75%, $2.00 Occupancy tax, and $1.50 Jacob Javits Center fee per room, per night.

• A credit card is required to make a reservation. • If you need to cancel your hotel room, please do so one day prior to

arrival to avoid cancellation fee. • Hotel Check-‐in time is 3 p.m.

2016 EASTERN CLAIMS CONFERENCE

OFFICERS DONNA A. CONTICCHIO, ALHC, HIA, ACS

PRESIDENT AIG BENEFIT SOLUTIONS

ANTHONY PENNA, ALHC

VICE-PRESIDENT GUARDIAN LIFE INSURANCE CO. (Retired)

STANLEY BRZOZOWSKI, ALHC

TREASURER NATIONAL BENEFIT LIFE (Retired)

ANN E. HEALY, FLMI/M FALU, FLHC, HIA, ACS, AIAA

SECRETARY

DIRECTORS STEVE ALLEN, FLHC, FLMI, ACS TRUSTMARK INSURANCE CO.

JENNIFER COBB, ALHC, CFE, FCLS

UNITEDHEALTHCARE

THEODORE P. DeVIVO AIG PROPERTY CASUALTY (Retired)

ED LOFTUS, ALHC, FLMI, CLU

GENERAL RE LIFE CORP. (Retired)

DANIEL W. MAGUIRE, ESQ. BURKE, WILLIAMS & SORENSEN, LLP

ROBERT G. MUNDER, CFE

PRINCIPAL LIFE INSURANCE CO.

JOHN J. PETRUCCI CHAIRMAN OF THE BOARD

STARR INDEMNITY & LIABILITY CO.

CONNIE WING, FLHC, FLMI FORESTERS

SPEAKER LIAISON

EMIL R. RAMIREZ, FLMI AXA EQUITABLE (Retired)

OF COUNSEL

WILLIAM P. WOODS, ESQ. AMERICAN GENERAL LIFE COMPANIES (Retired)

JOHN 'JOE' HEALY

CHAIRMAN OF THE BOARD IN MEMORIAM

2016 CONFERENCE CHAIR

JENNIFER COBB, ALHC, CFE, FCLS UNITEDHEALTHCARE

PROGRAM COMMITTEE

CHRISTINE PRUTTING CHAIRPERSON

AXIS ACCIDENT & HEALTH

SOPHIA AIKMAN MUNICH RE

STEVE ALLEN, FLHC, FLMI, ACS TRUSTMARK INSURANCE CO.

JENNIFER COBB, ALHC, CFE, FCLS

UNITEDHEALTHCARE

LORI COHEN, PH.D INDEPENDENT CLAIMS CONSULTANT NETWORK, LLP

DONNA A. CONTICCHIO, ALHC, HIA, ACS

AIG BENEFIT SOLUTIONS

MARLON FEARON, FLMI, ALHC, ACS SWISS RE LIFE & HEALTH AMERICA, INC.

ROBERTA FERLITA, ALHC, FCLA, AHFI

UNITEDHEALTHCARE

JONATHAN R. FREEDMAN, COUNSEL DISABILITY INSURANCE SPECIALISTS, LLC

KEVIN GLASGOW

MUNICH RE

JOHN K. HOFFMAN, CPA, CFF, CITP NAWROCKI SMITH, LLP, CERTIFIED PUBLIC ACCOUNTANTS

& BUSINESS CONSULTANTS

STAN KULESA SYMETRA

ANTHONY PENNA, ALHC

GUARDIAN LIFE INSURANCE CO. (Retired)

JOHN SEYBERT SEDWICK, LLP

KIMBERLY TOMASELLI, CPA, FLMI, ALHC

MUNICH RE

PROMOTION COMMITTEE

Supplies and Recognit ion Gifts KENETH H. NOWAK, ALHC

CHAIRPERSON METLIFE (Retired)

Ad Journal SOPHIA AIKMAN

MUNICH RE

ANN E. HEALY, FLMI/M FALU, FLHC, HIA, ACS, AIAA

ARLENE WALSH FOREST HILLS GROUP SERVICES, INC. (Retired)

FINANCE COMMITTEE STANLEY BRZOZOWSKI, ALHC

CONFERENCE TREASURER

NATIONAL BENEFIT LIFE (Retired)

ARLENE WALSH ASSISTANT TREASURER

FOREST HILLS GROUP SERVICES, INC. (Retired)

EXHIBITOR/HOSPITALITY COMMITTEE BRIAN LANDRY

CLAIMS BUREAU USA

LAURA CHEW CLAIMS BUREAU USA

WEBSITE COMMITTEE

THEODORE P. DeVIVO CHAIRPERSON

AIG PROPERTY CASUALTY (Retired)

TINA CHAWLA INTELLECT DESIGN

BARRIE BARKELY

PRUDENTIAL

ACCOMMODATIONS COMMITTEE

ROBERT G. MUNDER, CFE CHAIRPERSON

PRINCIPAL LIFE INSURANCE CO.

ANN E. HEALY, FLMI/M, FALU, FLHC, HIA, ACS, AIAA

SPEAKER LIAISON EMIL R. RAMIREZ, FLMI

CHAIRPERSON AXA EQUITABLE (Retired)

ED LOFTUS, ALHC, FLMI, CLU

GENERAL RE LIFE CORP. (Retired)

PATRICIA MURPHY, MBA, CLU, ChFC AXA EQUITABLE (Retired)

NEAL REGELS, FLMI, ACS, AIAA, AIRC, ARA, FLHC PHOENIX LIFE

REGISTRATION COMMITTEE

CONNIE WING, FLHC, FLMI CHAIRPERSON

FORESTERS

CINDY BELLEFOUNTAINE CUSTOM DISABILITY SOLUTIONS

CARMEN BRZOZOWSKI

CINDY HIGHAM

LAMONT, HANLEY & ASSOCIATES, INC.

TRENT LANDES RGA

KATIE SMALL

CUSTOM DISABILITY SOLUTIONS

MALA B. WALKER NEW YORK LIFE INSURANCE CO. (Retired)

MARKETING COMMITTEE

JENNIFER COBB, ALHC, CFE, FCLS UNITEDHEALTHCARE

TINA CHAWLA

INTELLECT SEEC

MELISSA J. THOMAS

Date Life Disability Professional Development

Legal Medical

Monday

March 14, 2016

10:00 a.m.– 11:15 a.m.

1. Hmm… Ask The Panel

* Fraud Track

2A. Social Security – Past, Present and Future SSDI Update

2B. Life…Down Under

3. Real Life Ethics Message: To Tell or Not to Tell * Fraud Track

4. When Good Rescissions Go Bad: Advanced Issues in the Rescission of Life and Disability Policies

5. Introduction to Data Mining Healthcare Fraud

*Fraud Track

Monday

March 14, 2016

1:15 p.m.– 2:30 p.m.

6. The difference between Medical Examiner and Coroner

*Fraud Track

7A. In the Hot Seat

7B. Claim Analytics

8. Real Life Ethical Dilemmas – An Interactive Group Workshop * Fraud Track

9. Trends in Life & Accident Insurance – Domestic and Abroad

10. Orthopedic Examination Findings – Red Flags to look for in a Medical Review

*Fraud Track

Monday

March 14, 2016

2:45 p.m.– 4:00 p.m.

11A. Group Life Claims…The Next Millennium

11B. Psychosocial function of claims management

12. On Solid Ground with Your Expert’s Opinion

13. Customer Service -‐ What if it was you?

14. Cutting Edge AD&D – What’s an Accident These Days?

15. Dental Schemes and Scams – Take a Bite Out of Fraud

*Fraud Track

Date Life Disability Professional Development

Legal Medical

Tuesday

March 15, 2016

9:00 a.m. – 10:15 a.m.

16. Marijuana in the Workplace – What Can an Employer Do?

17. The Great Financial Debate

18. Fighting Fraud with Advanced and Predictive Analytics

* Fraud Track

19. “Sorry, I Spent it” – the Effect of State Anti-‐subrogation Laws on the Administration of Claims for Benefits Under ERISA Governed Plans

20. Home Alone V…The Unreleased Sequel

*Fraud Track

Tuesday

March 15, 2016

10:30 a.m.– 11:45 a.m.

21. The Life Insurance Industry: Trends & Challenges

22A. Bad Faith Litigation

22 B. Legislative Update (ERISA)

23. Writing Effective Investigation Reports *Fraud Track

24. Health Care Fraud: Litigation *Fraud Track

25. Investigating & Prosecuting Kickback Schemes

*Fraud Track

Tuesday

March 15, 2016

1:45 p.m.– 3:00 p.m.

26A. Claim File Documentation and Preparing for Depositions

26B. Navigating the Ins and Outs of Claim Administration

27. Chronic Pain: What, Why, How, What YOU can do

28. Speed to Detection *Fraud Track

29. Hot Topics in ERISA Disability Law

*Fraud Track

30. Dissecting Medical and Dental Records

*Fraud Track

*Fraud Track=Directly Related Fraud Training & Awareness Session. NHCAA and ACFE approval is pending

2016 SPONSORS/EXHIBITORS

MLS Group of Companies Inc.2900 Inkster Road

Southfield, MI 48034

Ph. 888-657-4634Fax (248) 356-6757www.mis-ime.com

MIB50 Braintree Hill ParkBraintree, MA 02184

Ph. (781) 751-6136www.mib.com

Behavioral Medical Interventions

6600 France Ave. SSuite 245

Edina, MN 35435

Ph. (952) 641-0636Fax (952) 927-7147

www.behavioralmedical.com

Archangel Investigations & Protection, Inc.

5200 N. Century BlvdSuite 870

Los Angeles, CA 90025

Ph. 888-884-9644Fax (310) 836-6310

www.archangelincorporated.com

Medical Review Institute of America

2875 S. Decker DriveSuite 300

Salt Lake City, UT 84119

Ph. 800-654-2422Fax (801) 261-3189

www.mrioa.com

Lamont, Hanley and Associates, Inc.1138 Elm Street

Manchester, NH 03101

(603) 625-5547Fax (603) 647-5379

www.lhainc.com

Aquilan Technologies Inc.901 South MopacBarton Plaza One

Suite 300Austin, TX 78746

Ph. (512) 751-4226www.aquilan.com

ReleasePoint250 West First StreetClaremont, CA 91711

Ph. (213) 785-0404www.releasepoint.com

2016 EXHIBITORS

Claim Vantage Inc.34 Danforth Street

Portland, MA 04101

Ph. (207) 838-5075www.claimvantage.com

Fineos Corporation60 State Street

Boston, MA 02109

Ph. (617) 649-0018www.fineos.com

International Claim Associa-tion

1155 15th Street NW #500Washington, DC 20005

Ph. (202) 452-0143Fax (202) 530-5910

www.claim.org

Diligence International Group LLC

2810 Trinity Mills Road #209-337Carrollton, TX 75006

Ph. 800-660-4202Fax 888-802-4317

www.digroup-us.com

Benoit Language Services Inc.

33 South StreetNorthborough, MA 01532

Ph. 800-261-5152Fax (508) 393-4191

www.benoitinc.com

MCN Medical Consultants Network

1301 5th Avenue, Suite 2900Seattle, WA 98101

Ph. (206) 343-6100Fax (206) 287-1908

www.mcn.com

2016 EXHIBITORS (continued)

Advantage 2000 Consultants4121 Union Road

Suite 216St. Louis, MO

Ph. 800-899-3433Fax 866-848-1110

www.advantage2k.com

FastTrack1545 US Highway 206

Suite 100Bedminster, NJ

Ph. (610) 273-3623www.fasttrackrtw.com

DiGiStream230 N. Maple Ave.

Ste B1-171Marathon, NJ 08053

Ph. 800-687-9908www.digistream.com

ISO/Verisk Insurance Solutions

545 Washington BlvdJersey City, NJ 07310

Ph. (201) 469-3087www.iso.com

Covent Bridge Group9485 Regency Sq Blvd

Suite 400Jacksonville, FL

Ph. 888-932-7364www.coventbridge.com

ICORP Investigations535 Broadhollow Road B48

Melville, NY

Ph. (631) 285-7992Fax (631) 285-6993

www.icorpinvestigations.com

Coventry 3200 Highland Ave

Downers Grove, IL 60515

Ph. (860) 805-4362Fax 855-200-1833www.cvty.us.com

First Services PO Box 150601

Brooklyn, NY 11215

Ph. (718) 369-6300Fax (718) 369-7443

www.firstpi.com

iUnlimited InvestigationsPrinceton, NJ

Ph. (609) 442-6142Fax 877-275-2209

www.iunlimited.net

dear!friends!and!colleagues:!it-mis.com/easternclaims/pdfs/ecc_2016_invitation.pdfpage2!!...

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