HEALTHCARE FRAUD DETECTION

USING AI AND MACHINE LEARNING

HOTEL TOWERS ROTANA, DUBAI, UAE
NOV 6 - 7, 2023
08:00 AM – 04:00 PM (DUBAI STANDARD TIME)

25 DISCOUNT %
15 DISCOUNT % EXCLUSIVE GROUP OFFERS
2+1 OFFER: PAY $3,600
TILL SEPT 15, 2023 | $1,350 TILL OCT 10, 2023 | $1,530 for 3 participants
3+2 OFFER: PAY $5,400
for 5 participants

STAY ONE STEP AHEAD WITH ML AND AI-POWERED

HEALTHCARE FRAUD DETECTION FOR A SECURE INDUSTRY!

15.25 CPE
QUALIFIES TO BE ACCEPTED TOWARDS ACFE’S CPE CREDITS

Aleksandar Lazarevic (PhD, Machine Learning) Shauna Vistad

AI / Data Science / Data Analytics Executive | Keynote Speaker (MBA, AHFI, CFE, CPC, CFI)

VP, Analytics Hello Fresh, New York Senior Vice President, Medical Investigation & Audit,
National Health Insurance Company – Daman, Abu
PhD, Data Mining, Machine Learning, Predictive Dhabi, UAE.
Modelling, Temple University
MBA, University of North Dakota
MBA (ABD), Carnegie Melon University
B.Sc., Criminal Justice, North Dakota State University
MS in Computer Science & Engineering,
University of Belgrade Accredited Healthcare Fraud Investigator (AHFI), National
Health Care Anti-Fraud Association
Past: VP of Adv Analytics & Data Engr, Stanley Black &
Decker, Inc. Certified Professional Coder (CPC), AAPC
Past: Senior Director of Data Science, Aetna Certified Forensic Interviewer, Center for Interviewer
Past: Director of Decision Sciences, Commonwealth Bank Standards and Assessment
of Australia Past: Director, Medical Investigation & Audit, NHIC, Daman.
Past: Director, Personal Insurance Analytics, Travelers Past: Director, Special Investigation Unit, Oscar Health
Principal Data Scientist, UTRC Past: Program Manager, Fraud, Waste, and Abuse, CareFirst
BlueCross BlueShield
Past: Internal Auditor - Business Analyst, Stanford Health
Key Takeaways
Identify various types of healthcare fraud and conduct Learn how to quickly create and track key metrics (KPIs)
effective proactive investigations
Recognize what types of AI / ML approaches to use for
Learn how to detect fraud and abuse in health care and various health care fraud schemes
other relevant data
Understand how to use the right form of data analytics Learn from case studies and analyze the fraud in response
in investigations of the Covid 19 pandemic
Learn how to quickly develop visualization dashboards

Aleks has successfully helped many Fortune 500 companies accelerate their
top-line and bottom-line growth through data analytics, AI and machine
learning and enabled over $600M in value by focusing on relentless
discovery of business opportunities, flawless technical delivery and efficient
building high performing teams.
For online registration
CLICK HERE or contact Aly at training@acsmb.com
Course Overview
This course will provide a basic overview of healthcare fraud and its detection. It will start with covering main fraud schemes exploited
locally and globally, follow with providing a comprehensive introduction to the basic components of healthcare data, FAW experience
in GCC, overview of UAE regulations for Medical Audit & Recovery and finish with explaining how AI and Machine Learning can be used
to identify potential fraud, waste and abuse in the public and private payer systems. The software tools and different AI / machine
learning methods will be reviewed as well as the newest fraud detection methods based on deep learning. Proactive algorithms used
to identify real time large investigations will be reviewed with case studies examined.

Course Benefits / Learning Objectives

Completion of this course will provide attendees with a basic understanding of main AI / machine learning methods that could be used
for detecting healthcare fraud ranging from developing visualization dashboards for faster and more efficient fraud investigation to
creating more advanced predictive models for automated detection of various types of fraud.

Learning Outcomes
Define healthcare fraud, waste and abuse
Understand various types of healthcare fraud
Provide examples of the most common fraud schemes
Explain key methods of collecting evidence of healthcare
fraud
Describe the basic principles of data analytics ranging from
descriptive and diagnostic analytics to predictive and
prescriptive analytics using AI and machine learning
Explain how visualization dashboards are used for faster fraud
investigation
Explain major directions how machine learning (predictive
modeling, anomaly detection, link analysis) could be applied for
healthcare fraud detection
Provide case studies where data analytics helped in health care
fraud detection

Instruction Methodology / What is Included?

Group discussions focused on real-world case studies Live exercises for each attendee
Use of videos, images and brainstorming techniques for Individual assignments
quality learning Course material
Online quizzes Certificate of Achievement
Daily feedback of previous day course activities

Target Audience
Departments Level
SIU/MIAD - Audit and investigations departments Directors
Data Analytics and business intelligence Managers
Medical cost containment Auditors
Fraud Adjudicators
Compliance Supervisors
Medical claims Senior Officers
Reimbursement Analysts
Revenue Cycle Management Attorneys
Strategy
Risk

Fee & Discount

Course Fee Individual Fee & Discount Exclusive Group Offers

(25% OFF) (15% OFF) 2+1 Offer: $3,600 for 3 participants
$1,800 Till Sept 15, 2023 Till Oct 10, 2023

$1,350 $1,530 3+2 Offer: $5,400 for 5 participants

Note:
1- Participants in groups can only avail either 2+1 offer or 3+2 offer or flat 25% discount.
2- All ‘Early Bird’ Discounts must require payment at the time of registration and before the cut-of date in order to receive discount.
3- Registered person if refers someone from a different organization will get 5% refund provided the referred person registers.
4- Payment can be done online or via bank wire
5- Event price is exclusive of any tax that may apply.
6- 2.9% charges inclusive for online payment.
7- To avail the discount offer:
a) the registration and the payment is required to be received within the defined time frame
b) participants should be from same organization
Earn 15.25 CPE
Qualifies to be accepted towards
ACFE’s CPE credits
For online registration
CLICK HERE or contact Aly at training@acsmb.com
 Aleksandar Lazarevic , (PhD, Machine Learning)
AI / Data Science / Data Analytics Executive | Keynote Speaker

VP, Analytics Hello Fresh

PhD, Data Mining, Machine Learning, Predictive Modelling, Temple University
MBA (ABD), Carnegie Melon University
MS in Computer Science & Engineering, University of Belgrade
Past: VP of Adv Analytics & Data Engr, Stanley Black & Decker, Inc.
Past: Senior Director of Data Science, Aetna
Past: Director of Decision Sciences, Commonwealth Bank of Australia
Past: Director, Personal Insurance Analytics, Travelers Principal Data
Scientist, UTRC

Aleks has been doing Data Analytics / Data Science for almost 20 years. He has been doing a lot of innovative research, but he has
also led many analytics organizations across the multiple Fortune 500 companies such as Stanley, Black & Decker, Aetna, Travelers
and Raytheon (previously United Technologies Corporation). He helped many them accelerate their top-line and bottom-line
growth through data analytics, AI and machine learning and enabled over $600M in value by focusing on relentless discovery of
business opportunities, flawless technical delivery and efficient building high performing teams.
He has been continuously recognized for his scientific and leadership work in this area. He has been recently voted a Top 100 Data
Innovator by Corinium Chief Data Officer community, and his analytics organization at Stanley Black & Decker has received a highly
prestigious nation-wide FutureEdge50 Award, rewarded by CIO (IDG.com) for organizations pushing the edge with new technolo-
gies.
Aleks has immensely contributed to data analytics community through many publications, patents and professional services. He
has written a book on data analytics in cyber security and published eight book chapters and over 50 research data science
articles, which were cited more than 6,500 times. In the last few years, he has been popularizing data science / analytics by giving
invited / keynote talks at Chief Data Analytics Officer events, Gartner Executive summits, and other data science conferences.
He earned his PhD degree in Machine Learning from the Computer and Information Science Department at Temple University in
Philadelphia.

Awards-winner:
Top 10 Data Analytics Leaders for the North America
Top 100 Global Data Innovator
FutureEdge50 Award

Some of the professional highlights include:

News / article about my work: HealthWire / ArcWeb: Aetna is taking on insurance fraud with machine learning
CIO Applications articles:
Quo Vadis Data Science?
QuantumComputing in Data Analytics
Forbes.com Technology Council member and DataRobot Advisory Council member
Technical Board advisor: Anomaly / Redesign Health, R2.ai
Frequent speaker at data science / analytics conferences
Invited Speaker/Panelist at Chief Data Analytics Officer events, Boston, Nov 2019 & Florida Jan 2020, virtual event -
August 2020
Invited talk at the Gartner CIO Executive Summit, October 2019
Invited talk at Open Data Science Conference (ODSC), Boston, 2017, 2018 and 2019.
Invited Talk at Cognitive Computing AI Analytics Symposium, Temple University, November 2017
Invited talk at Predictive Analytics World in Health Care, New York City, October 2017
Talk at the Strata + Hadoop World Conference, Ignite event, New York City, September 2017
Keynote talk at IEEE International Conference on Health Informatics, Park City, UT, August 2017
Invited talk at Big Data Analytics Summit, Philadelphia, May 2017
Talk at National Health Care Anti-Fraud Association Conference, Atlanta, November 2016
Consulting Data Science: Delaware State University (2006–2011), Tesla Science Foundation (2010-2012)
Advisory Board Member for MS program in Health Informatics at Drexel university, 2017-present

For online registration

CLICK HERE or contact Aly at training@acsmb.com
 Shauna Vistad, (MBA, AHFI, CFE, CPC, CFI)

Senior Vice President, Medical Investigation & Audit, National Health Insurance Company – Daman, Abu Dhabi, UAE.
MBA, University of North Dakota
B.Sc., Criminal Justice, North Dakota State University
Accredited Healthcare Fraud Investigator (AHFI), National Health Care Anti-Fraud Association
Certified Professional Coder (CPC), AAPC
Certified Forensic Interviewer, Center for Interviewer Standards and Assessment
Past: Director, Medical Investigation & Audit, NHIC, Daman.
Past: Director, Special Investigation Unit, Oscar Health
Past: Program Manager, Fraud, Waste, and Abuse, CareFirst BlueCross BlueShield
Past: Director, School Board, West Fargo Public School District
Past: Provider Education and Auditor, Trinity Health
Past: Internal Auditor - Business Analyst, Stanford Health

Shauna Vistad is currently the Senior Vice President for Medical Investigations and Audits at Daman.
She brings more than 15 years international leadership experience with a decade of her work dedicated to healthcare fraud, waste,
and claims abuse from both a payer and provider perspective. She has built and/or revamped four FWA units with a focus on the
use of data in driving investigations. She has extensive healthcare fraud expertise and as a recognized industry figure who has
spoken for international organizations including the National Health Care Anti-Fraud Association (NHCAA), American Academy of
Professional Coders (AAPC), International Travel and Health Insurance Conferences (ITIC).
Ms. Vistad is an Accredited Healthcare Fraud Investigator (AHFI), Certified Professional Coder (CPC), Certified Fraud Examiner (CFE)
and a Certified Forensic Interviewer (CFI). She holds a bachelor’s degree in Criminal Justice from the North Dakota State University
(NDSU) and a master’s degree in Business from the University of North Dakota.

“I have attended a post- graduate program in data science but didn't know how to apply it in my
current job role. In this training, it gave me a lot of insights in applying my basic knowledge in data
science, learn more about advanced methodologies in fraud detection and create advanced analyt-
ics dashboard visualizations. Thanks Aleks for sharing your expertise with us.” TRAINEE
TESTIMONIALS

“In total, nice training/webinar. Very well explained by Aleks the trainer. Interactive sessions were
good, best wishes.” TRAINEE

“Sharing concrete case studies (what kind of analysis methods and underlying data have been
used for what kind of FWA detection, and with what success) and examples of PowerBI (or similar)
dashboards was the best part and met my expectations.” TRAINEE
“The depth of examples covered. The examples were very specific and very helpful. I appreciated
the examples of the end output for each of the examples as well.” TRAINEE
“The training was incredibly useful and informative. The content delivered was very comprehen-
sive and interesting. Looking forward for more opportunities to participate in related
training areas.” TRAINEE

In - House Training
If you want us to conduct this course as an in-house for
your facility and get you the quote, then you may email
us with little more information about your requirements?
1. Name of topic?
2. Classroom or virtual live?
3. Expected no. of participants?
4. Expected timeframe (when and for how many days)?
5. Any specific requirements?

For online registration

CLICK HERE or contact Aly at training@acsmb.com
Course Schedule

Day 1 – Nov 6, 2023

07:45 AM - 08:00 AM Registration, Kick off and Introduction
08:00 AM - 10:00 AM Session One: FWA, AI, Machine Learning, and Local Trends.

GCC v Western Health Care Systems

Most common fraud schemes in US and internationally
Examples of FWA experience in GCC
UAE Regulations for Medical Audit & Recovery
Usual Prevention & Detection and Investigation measures used in UAE and GCC region
How local regulations can impact off the shelf analytics
Ways Machine Learning will adapt your future analytics
Current local trends
How AI can provide insights to address shifting local trends
Group Case Study - based on a real-life experience

10:00 AM - 10:20 AM Coffee/Tea Break and Quiz

Session Two: Basic Machine Learning Applications in Health Care Fraud Detection – EDA,
10:20 AM - 11:50 AM
Reporting & Dashboards
The Evidence of Healthcare Fraud and How to Collect it / Discuss what data to analyze
What kind of data is available for the health care fraud detection?
What kind of EDA is useful in health care fraud detection?
What is Data Analytics?
Descriptive, Diagnostic, Predictive and Prescriptive
Importance of Descriptive & Diagnostic Analytics
When we need Predictive & Prescriptive Analytics
Fundamentals of Descriptive Analytics – Exploratory Data Analysis (EDA) / BI Reports / Visualization

11:50 AM - 12:50 PM Lunch Break & Quiz

12:50 PM - 14:20 PM Session Three: Descriptive / Diagnostic Analytics in Action to Combat Health Care Fraud
Visualization Dashboards
How to do efficient EDA?
How to develop effective and outcome driven dashboards?
What skills to build?
What tools / vendors to consider?
What KPIs to report?
How to convert your FWA expertise into business rules that could be run automatically every day
/ hour / week? – Case studies and Roundtable discussion

14:20 PM - 14:40 PM Coffee/Tea Break

14:40 PM - 16:00 PM Session Four: Visualization Dashboards / Tools
Building business rules in practice – real world example with realistic data
Simple examples of visualization dashboards / tools to help fraud investigation
Quick exercise in building a dashboard
Possible demo of some of these visualization tools / dashboards

Wrap up discussion

For online registration

CLICK HERE or contact Aly at training@acsmb.com
 Day 2 -Nov 7, 2023
07:45 AM - 08:00 AM Review of previous day learning sessions and data analytics discussed
Session One: Deep Dive on Machine Learning in Health Care Fraud Detection - Case Studies
08:00 AM - 10:00 AM
and Round Table Discussions

Fundamentals of Machine Learning - Predictive & Prescriptive Analytics

Major types of Machine Learning (e.g., classification, regression, association rules, clustering,
text analytics, anomaly / outlier detection, etc) and relevant examples
Common use cases where Machine Learning is used but you may not know it
Common health care use cases where e AI / machine learnings used today
Bringing data to your environment (data ingestion) and data preparation (data wrangling
/ preprocessing)
Effective feature construction for successful fraud detection using ML / AI
How basic AI and machine learning could be used to fight health care FWA?
Business rules – quick review from previous day
Classification models – detecting variations of know health care fraud
Common challenges and risks using classification predictive models

10:00 AM - 10:20 AM Coffee/Tea Break and Quiz

10:20 AM - 11:50 AM Session Two: Predictive / Prescriptive Analytics in Action to Combat Health Care Fraud

How advanced unsupervised AI and machine learning could be used to fight health care FWA?
Feature generation for unsupervised learning
Clustering approaches for fraud detection
Anomaly / Outlier Detection – detecting novel types of health care fraud
Link Analysis – detecting fraud rings and nation-wide organized fraud groups
Doing your homework – assets, marital and financial status, bankruptcies/divorces/substance abuse
data
Common challenges and risks using unsupervised ML models for fraud detection
AI and machine learning for Post-pay vs. Pre-Pay Fraud Detection
Reviewing actual use cases of successful investigations from AI and machine learning
Round table discussion on possible fraud use cases and how AI and machine learning could help

11:50 AM - 12:50 PM Lunch Break & Quiz

12:50 PM - 14:20 PM Session Three: Reviewing Use Cases of Investigations and Round Table Discussion on
Possible Use Cases
What’s next after you build you data analytics solution? Deploying the analytics solutions
What it takes to successfully adopt your analytics solution?
Reviewing actual use cases of successful investigations from AI and machine learning
Round table discussion on possible fraud use cases and how AI and machine learning could help

14:20 PM - 14:40 PM Coffee/Tea Break

14:40 PM - 16:00 PM Session Four: Open Group Discussions / Analyzing How to Address and Apply ML & AI

Open discussion of the course

Each participant will come prepared with their own fraud use case and we will work together to
analyze how to address it and how to apply machine learning and AI
Quiz and discussion of responses

Closing, Certificate Distribution, and End of Course!

For online registration

CLICK HERE or contact Aly at training@acsmb.com
 REGISTRATION FORM
HEALTHCARE FRAUD DETECTION USING AI AND MACHINE LEARNING
HOTEL TOWERS ROTANA DUBAI | UAE
NOV 6 - 7, 2023

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