HICFG Training Conference - Health Insurance Counter Fraud Group

2013
HICFG Training Conference
Latimer Place, Chenies
Contents
03
Conference Venue Information
04
Welcome from Caroline Heneghan, HICFG Chairperson
05
Historical Review of HICFG
06
Raymond Collins, HICFG Directors Report
07
Conference Schedule
08
Networking Opportunities
09
Master of Ceremonies, Ted Doyle, Biography
10
List of Conference Speakers
11
Conference Speaker Biographies
12
HICFG Award Winners
13
HICFG Member Companies
13
HICFG Associate (Vendor) Members
13
HICFG Conference Sponsors
14
Structure and Mission of the HICFG
15
4 Simple Steps to Share and Use HICFG Intelligence
WELCOME
Welcome to the 2013 HICFG Annual Training Conference.
The HICFG Training Conference provides an opportunity
for investigators, clinical staff, claims administrators,
underwriters, auditors, and medical directors to share
best practices and learn about the latest industry
developments. Healthcare fraud is a global problem that
needs all players to be engaged and working together.
LATIMER PLACE
Latimer Place is nestled within 30 acres of beautiful lawns and
woodland. This facility features outdoor activities including:
croquet and trim trail.
Interested in sightseeing before or after the HICFG Conference?
Latimer Place is five minutes from the Chalfont & Latimer Station.
Either a mainline train or the Metropolitan Tube line will take
you to London Marylebone in just 35 minutes. You may enjoy
such attractions as: Tate Modern, the Natural History Museum,
the London Eye, Madame Tussauds, the Tower of London,
Buckingham Palace, and so much more!
We hope you thoroughly enjoy the HICFG Conference and your
stay at Latimer Place.
Latimer Place,
Chenies, Buckinghamshire
United Kingdom HP5 1UG
T: 0844 980 2312
F: 01494 765704
E: latimer@devereevenues.co.uk
W: deverevenues.co.uk
03
Conference Venue Information
Upon Arrival
Facilities
Please go straight to the reception desk to check in. Room keys
will be available after 2:00pm on day of your arrival. Should you
choose to arrive prior to 2:00pm, you may store your luggage at
the reception desk.
Restaurant
Room Amenities
Bar
All bedrooms are en-suite with wifi internet access, televisions,
trouser presses/ironing stations, hair dryers, tea/coffee making
facilities, and direct dial telephones included.
Wednesday/Thursday - 5:00pm – Late
Friday - 12:00pm - Midnight
Phone call charges are 20p per unit. These charges will be added
to your room bill at the end of your visit.
Laundry service is also available to all Latimer Place guests.
Clothing may be collected from your room and returned with
24-hour turn around time. This service, should you choose to
utilize it, is an additional charge that would be added to your bill
at the end of your visit.
Room service is available from 11:00am – 9:45pm.
Leisure
Azure Health and Fitness Centre includes a gym, swimming pool,
Jacuzzi, and sauna/steam room.
After the Conference
Latimer Place check out time is 9:30am.
Breakfast (Buffet) - 7:00am – 9:30am
Lunch (Buffet) - 12:30pm – 2:00pm
Dinner (Plated) - 7:00pm – 9:00pm
(Bar snacks are available up until 10:00pm)
04
Welcome from Caroline
Heneghan, HICFG Chairperson
I would like to welcome you to the 2013 HICFG Annual Training
Conference. The Association is in its 13th year as an industry
network. This is our 6th annual conference and each year the
gateway that the HICFG provides for insurers and staff that service
the risk side of the business is extended.
We welcome new members including our vendor members and
other guests looking to share trade craft and methodology that will
hopefully prevent fraud, abuse and waste within the industry.
The HICFG is a meeting point for the health insurers organised by the
health insurers. Our primary goal is to share intelligence, maintain
personal networks and educate staff in order to prevent fraud.
I hope you enjoy this conference and get to know one another.
I hope you continue to support the network and our centralised
intelligence sharing association. We have a fantastic schedule of
speakers and networking events. I look forward to your continued
support of the HICFG.
Regards,
Caroline Heneghan
HICFG Chair – Bupa UK
05
Historical Review of HICFG
The Health Insurance Counter Fraud Group was commenced in July 2001 by a number of
large insurers. There was little awareness of health care fraud in the UK until about 2000.
In 2000, the National Health Service (NHS) CounterFraud and Security Management Services began
highlighting cases of fraud and obtaining prosecutions.
The goal back then remains the same today - to prevent
and detect fraud within health care.
by over 30 health related insurance companies including the ten largest private medical insurers.
The membership includes serious and critical illness
insurers, re-insurers, international, health-related,
expat insurers, and cash back health insurers.
The group met originally to discuss issues of common
interest and to exchange information and suspicions
about potential frauds under an agreed terms of
reference. Initially, Aviva (Norwich Union) and AXA
PPP health care conducted joint investigations, but
cooperation soon increased as it became apparent
that the same fraudsters were being identified
scamming multiple companies, often at the same
time. As a result of collaboration and sharing of
intelligence, cases have been presented to both
criminal courts, General Medical Council, and
other professional bodies. Civil redress and criminal
convictions have been obtained by health insurers.
This can be attributed to the coordinated efforts of
the industry to stamp out fraud.
The HICFG provides members a technical platform
in which to share intelligence in order to prevent
and detect fraud within health care. The HICFG also
offers an accredited training course, holds an annual
conference, and provides its members with bespoke
technology specific to the industry. The HICFG works
closely with its domestic partners, National Health
Service Protect (NHS) sharing a Memorandum of
Understanding (MOU). This is replicated with NHS
Counter Fraud Scotland and NHS Counter Fraud
Northern Ireland. The HICFG holds a relationship
with the Insurance Fraud Enforcement Department
and National Fraud Authority, City of London
Police, Insurance Fraud Bureau, and the Insurance
Fraud Investigators Group to facilitate the cycle
of intelligence and undertake joint investigations
into fraud. The HICFG has formal relationships with
health Anti fraud associations in the U.S.A, Europe,
Canada, Persian Gulf, Australia, Middle East, South
East Asia and South Africa. Health care fraud knows
no borders.
In 2011, the HICFG in co-operation with the National
Health Care Anti Fraud Association USA (NHCAA),
Canadian Health Care Anti Fraud Association
(CHCAA), European Health Fraud and Corruption
Network (EHFCN), and Healthcare Forensic
Management Unit South Africa (HFMU) commenced
a global association known as the Global Health
Care Anti-Fraud Network. This saw the partnering
countries and regions signing the GHCAN MOU. For
further information on this important alliance please
visit: www.ghcan.net.
In 2012, the HICFG (in partnership with the
Association of British Insurers) is subscribed to
Last year, the HICFG successfully hosted the second
annual Global Health Care Anti-Fraud Network summit.
It included 220 delegates from 23 different countries.
If your company is interested in membership or associate
membership with the Health Insurance Counter Fraud
Group, please contact us at: www.hicfg.com.
06
Raymond Collins,
HICFG Directors Report
Welcome to the 2013 Health Insurance Counter Fraud
Group (HICFG) Annual Training Conference (ATC).
I would like to welcome our new vendor members: Keoghs, G4S,
CMC HIBIS, Performant Corp and RMH. You are welcome additions
to the Association. We look forward to seeing and hearing about
your products and services at this conference, throughout the next
year, and many years to come.
I would like to take this opportunity to thank all steering committee
members, our Chairperson, Caroline Heneghan, and our Treasurer,
Dawn Brockman, for another outstanding year and for providing an
organised association to the health insurance member companies
that we serve. Caroline’s ongoing support and efforts during the last
18 month have been fantastic, and she has represented the position
well. Dawn has also done a superb job of chasing and reporting on
the associations’ finances.
Thank you to Jim Stedall, the custodian of the HICFG governance
documents, and the Association of British Insurers who provide
many of the support services to the group (such as banking and
finance, media and meeting rooms). Finally, I’d like to acknowledge
and thank the Insurers as well as their staff that support the HICFG.
I hope you enjoy a great conference.
Regards,
Ray Collins
Director
06
(cont)
HICFG Directors Report
The HICFG, supported by the Association of British Insurers, offers members an array
of services and software to assist the business units and staff dedicated to preventing
fraud, waste and abuse within healthcare.
In 2013 the HICFG provides three tools to health
insurance companies to share intelligence about
suspect billers and claimers. First, the health fraud hub
www.healthfraudhub.com connects the insurers of the
UK, Europe and the Persian Gulf and provides staff with
up to date news, events, fraud prevention tools and
rules. In essence it is our networking platform.
Second, the Health Intelligence Fraud Investigation
Database (HIFID) provides a central internet database
where health insurers and public health investigators
can load intelligence to enable HICFG member
companies to identify fraudsters. HIFID automatically
connects subjects, allowing industry investigators
to understand behaviour and prevent recidivism. To
understand and deal with a fraudulent bill or claim is
one thing, but maintaining the intelligence cycle and
ensuring competitors do not become a victim is a way
to change behaviour. The Health Insurance industry
database, HIFID, is currently populated with over 17,000
names of high-risk billers and claimers.
Collecting and collating intelligence is a start.
Understanding the network connections, modus
operandi and being able to use those high-risk names
is the key to saving money and preventing loss in real
time. In partnership with IMT Compliance, the HICFG
provides its members with bespoke healthcare fraud
case management software to achieve this. Thus,
the third tool, the Fraud Intelligence Manager (FIM),
is designed to reside on your company’s server and
act as a fraud investigation and intelligence case
management system. It enables you to isolate and
work your own companies’ investigations securely,
privately and in a logical manner. It is easily integrated
into your claims system to operate in tandem with
current claims management. FIM produces financial
crime reports based on you investigations. Uniquely,
FIM streams into your company, every 3 minutes, all
of the high risk billers and payers uploaded into the
industries HIFID database. That intelligence is retained
by your company. FIM provides you with a complete list
of your own fraud intelligence combined with industry
intelligence. The system can be integrated against your
own billing, claiming and new business data sources
to prevent suspicious payments, claims and high risk
policy holders affecting your company. FIM is your
industries domain knowledge, it’s your intelligence, it’s
your competitor’s fraud intelligence and it’s available
via the HICFG to allow you to stop & know rouge billers
and claimers from abusing health insurance.
The steering committee format also saw some change.
The HICFG pioneered sharing of health Insurance fraud
data. We have been doing this electronically amongst
our membership for over six years. The custodians of
sharing fraud data within health insurers in the UK were
Dr Simon Peck (Axa ppp), Steve Moody (Aviva), Neil
Davidson (WPA), and Joan Elliott (Bupa). Brave enough
to champion the beginnings of the HIFID system.
We now have, a pool of 17,000 high-risk names, the
rational behind the risk and how to prevent loss sits in
the HIFID database ready to be exploited via FIM. As a
result of hard work, the steering committee is now able
to focus its attention on a maintenance meeting. We
are in the process of maintaining the current initiatives
we have in place. In 2014, we plan to commence both
an investigators meeting and vendor product meeting
that will encourage in person networks. The networks
will be designed to provoke discussions about how
06
(cont)
HICFG Directors Report
Training has gone from strength to strength. Training
partner RMH has raised the bar in the effort to accredit
insurer investigators in line with NHS Protect. They
have supported the ATC and provide each of you with
a continual professional development certificate (CPD)
as a part of the ongoing commitment of the health
insurers in the United Kingdom--to ensure staff training.
In 2012 the HICFG successfully hosted
the Global Health Care Anti Fraud
Network annual summit which included
delegates from
different
countries
220
23
HICFG IN
NUMBERS
The HICFG maintains a network and pathway to its
domestic partners such as NHS Protect as well as the
Global Health Care Anti Fraud Network (GHCAN) which
consists of similar associations globally. All members
should be aware of these networks. Please contact us
if you have any questions or need assistance to use
this network. The GHCAN holds an annual summit in
In 2013 the HICFG Health Intelligence Fraud
Investigation Database currently holds around
names of high risk
billers and claimers
17,000
a different country each year. The HICFG investigator of
the year is funded by the HICFG to attend that summit.
This year’s summit was held in Toronto. In 2014, the
summit will be held in South Africa.
The HICFG increased its membership in 2013 with the
induction of Baker Tilly. This is a significant membership
for the HICFG with Baker Tilly being the largest provider
of counter fraud services to the NHS. Please make David
Foley welcome and we look forward to the tradecraft
and methodology that will be shared as a result of this
alliance with the HICFG.
In 2013 the HICFG has memorandums of understanding
with 3 public health bodies across Great Britain and
5 international trade associations that represent
public HEALTH and
private health
INSURERS globally
300
over
to prevent and detect fraud, waste and abuse within
healthcare (the core focus of the HICFG).
In 2014 The HICFG membership will consist of
companies.
36
07
Conference Schedule
Thursday 7th Nov
0730 - 0850
Registration Coffee and tea for delegates in the vendor exhibit area
0915 - 0930
Welcome Conference opening and welcome by HICFG Director Ray Collins
0930 - 1010
Tom Sackville - NHS management accountability & structure
1010 - 1030
Coffee Break Vendor exhibit area
1030 - 1110
Paul Guile MA, MCIPS - Procurement fraud prevention and detection
1110 - 1130
Coffee Break Vendor exhibit area
1130 - 1210Paul Mewett of Performant Corp - The use of social analytics and health care
investigations
1210 - 1330
Lunch Buffet lunch to be served in the vendor exhibit area
1330 - 1400Simon Winnard of Keoghs Solicitors - Use of legal services to prevent and detect fraud
in healthcare
1400 - 1430Di Hendry & Andrew Lawrence of Monmouth Partners - Clinical Billing, preventing
and detecting loss
1430 - 1445
Coffee Break Vendor Exhibit Area
1445 - 1545Detective Inspector Dave Wood of IFED - Police working with insurers. The story so far
1545 - 1615
Bill Mahon of MCG - The culture and logistics of setting up a Special Investigations
Unit (SIU)
1615 - 1645
Nikki Grieve Top of BUPA International - The psychology of a fraudster
1645 - 1730Vendor Cheese & Wine Delegates are invited to attend the vendor cheese and
wine reception. A prize draw will be held
1900 - 1945Champagne Reception Delegates are invited to the champagne reception
in the library
2000 - until lateNetworking Awards Dinner Dinner featuring live entertainment from the “Alistair
Webster Band” Followed by Karaoke in the D-Liscious bar!
Friday 8th
0930 - 1030Sue Pawar Price & Kate Archer of Mills & Reeve Solicitors - Data Protection, how and
why you can share intelligence and the new European Directive
1030 - 1100
Coffee Break Vendor Prize Draw
1100 - 1200Dr Kirstyn Shaw of the GMC - Regulating Doctors; Investigating concerns about
fitness to practice
1200 - 1245Close of Conference - Ray Collins introduces the incumbent HICFG chair and
current HICFG chair Caroline Heneghan
08
Networking Opportunities
Thursday 7th Nov
1210– 1330Luncheon Delegates are invited to enjoy hot and cold buffet lunches in the vendor
exhibit area - just outside of the main conference room
1645 – 1730Vendor Wine & Cheese Delegates are invited to attend a wine and cheese reception
in the vendor exhibit area - just outside of the main conference room. Note: a prize draw
will be held!
1900 – 1945Champagne Reception Delegates are invited to attend a champagne reception
in the library
1955 - 2020
HICFG Investigator of the Year Awards
2000 – until lateNetworking Dinner Delegates are invited to attend a networking dinner featuring live
entertainment from the “Alistair Webster Band”
Dress code - Lounge suits for the men and cocktail dresses for the ladies
Until later Karaoke Delegates are invited to participate in karaoke in the D-Liscious bar
Friday 8th
1245 – 1345Luncheon Delegates are invited to enjoy hot and cold buffet lunches in the vendor
exhibit area - just outside of the main conference room
09
Master of Ceremonies,
Ted Doyle, Biography
Ted Doyle is currently serving as Vice President, Healthcare Markets
for Performant Financial Corporation. His experience is that of a
senior leader in health care administration and payment integrity
for both the private and public health care sectors.
Doyle’s background includes over 29 years of experience in the
detection, investigation and prevention of health care fraud, waste,
and abuse for United States and international health care payers.
Doyle has been responsible for the development of innovative and
leading edge analytics that have significantly reduced health care
administrative costs through enhanced detection of fraudulent,
wasteful, and abusive claims. He has also been in charge of the
development of domestic and international market strategies for
payment integrity services and solutions. Doyle has experience
across all segments of health care payer responsibilities including:
claims administration, customer service, quality assurance, audit,
appeals, payment policy, and contract & network administration.
Doyle is a frequent speaker at US and International conferences
focused on Health Care Anti-Fraud and Payment Integrity initiatives.
He is the recipient of numerous anti-fraud awards, including: the
United States’ Health & Human Services (HHS) Secretary’s Award,
Centres for Medicare & Medicaid Administrator’s Award, HHS
Inspector General’s Cooperative Achievement Award, and Federal
Bureau of Investigation’s Director’s Awards.
10
LIST OF Conference SpeakerS
Tom Sackville
Paul Guile
Nikki Grieve–Topp
Simon Winnard
David Wood
Sue Pawar Price
Kate Archer
BILL MAHON
Paul Mewett
Kirstyn Shaw
Di Hendry
Andrew Lawrence
11
Conference Speaker Biographies
Tom Sackville
Hon. Thomas Geoffrey Sackville, a former a British Conservative politician, is the current
CEO of the International Federation of Health Plans (IFHP).
The IFHP was founded in 1968 by a group of health insurance industry leaders, and is now the leading global
network of the industry. IFHP’s mission is to assist in the maintenance of highly ethical and professional
standards throughout the health plan/insurance industry.
Sackville is a former Home Office minister and was a Member of Parliament for Bolton West 1983 to 1997.
Paul Guile
Paul Guile is a Global Procurement Fraud Advisor for the Chartered Institute of Purchasing
and Supply.
Guile has over 20 years of investigative experience gained from UK and international police service posts.
He has also held senior management positions in both the fraud and security arenas—in both public and
private sectors. He has managed high-value complex investigations including: corporate fraud, bribery,
corruption, and procurement fraud within challenging commercial and financial environments.
Guile has delivered Procurement Fraud Training internationally to locations including, but not limited to, the
African regions, across the Middle East, Laos, China, and Malaysia. This training has been delivered to diverse
organisations such as: the World Bank, African governmental departments, UK cabinet offices, mineral and
precious metal mining groups, oil and gas corporations, and global banking regulators and organisations.
Nikki Grieve–Topp
Nikki Grieve-Top is a Health Risk Manager for Bupa International.
Over the past few years, great strides have been made in the application of learnings from cognitive, social,
investigative and organisational psychology that are of direct relevance to suspect claims management. The
importance of these developments has been recognised by an increasing number of businesses and crime
prevention agencies involved in counter fraud processes.
Grieve-Top’s experience includes: counter fraud consultancy work with the Markerstudy Group and Crawford
& Company, serving as the Head of Fraud for Acromas Insurance Company Limited (SAGA), and posts as an
Investigative Psychologist for Conversant Data and Innovation Group among other impressive roles.
Simon Winnard
Simon Winnard is the Director of Healthcare Fraud for Keoghs.
Winnard has worked in the healthcare industry for 20 years—across both the private and public sectors. He
has worked with a number of Secondary and Primary Care Trusts, GP practices and the North West Strategic
Health Authority for the National Health Service (NHS). In the private sector, Winnard has a wide range of
experience through numerous roles with BUPA, BMI, Standard Life Healthcare (SLH), and PruHealth. He is
passionate about countering healthcare fraud and considered to be an expert in this field.
Winnard is a past Chair of the Health Insurance Counter Fraud Group (HICFG) and was also a steering group
member of the Global Health Care Anti-fraud Network (GHCAN), bringing together similar counter fraud
bodies in the US, Europe, Australia, and South Africa.
David Wood
David Wood is the Head of the City of London’s Insurance Fraud Enforcement Department
(IFED), a specialised police unit dedicated to tackling insurance fraud across the UK.
In its first year of operation, the Department was credited with investigating £12 million worth of insurance
fraud and, in the process, made 260 arrests, secured 76 cautions, and attained 11 convictions. In 2012, Wood
became the public face of IFED when he and his team were highlighted in the BBC series, Claimed and
Shamed. Claimed and Shamed focused on exposing insurance fraud violations.
Wood joined the City of London Police in 1984 and has held the following positions: Detective Chief Inspector,
Superintendent, Homicide Inspector, Surveillance Squad member and Post-riot Investigation team member.
He has also been awarded the Police Long Service and Good Conduct Medals of Honor.
Sue Pawar Price
Sue Pawar Price is a dually qualified lawyer and practising barrister in fraud.
Price represents clients’ interests at inquests, and she prosecutes and defends cases in the criminal courts
(Magistrates’ Court and Crown Court level).
Fraud cases require a completely different skill set to non-fraud cases. Price’s expertise in both the civil arena
and the criminal domain enable her to adopt a holistic approach to a case, offering her clients the best
possible solution in the most cost effective environment.
Price qualified as a solicitor in 1999 with a large composite insurer. She became a partner in private practice
in 2006, was called to the Bar in 2010,
11
(cont)
Conference Speaker Biographies
Kate Archer
Kate Archer is a Partner and Legal Specialist who resides on the Insurance Disputes team with Mills & Reeves.
Archer handles catastrophic injury claims that require her to issue pragmatic and timely advice to clients in
order to encourage early claim resolutions. She provides policy coverage and indemnity advice as well as legal
representation at the police station and at the coroner’s court. In other words, those occasions when clients
require very sensitive and exceptionally straight-forward advice. Clients describe Archer as their “go to” lawyer
in the Midlands and their first port of call when a crisis occurs. According to Archer, her clients expect a fastpaced delivery of sensible advice that will allow them the opportunity to make the best informed decisions
as to defending a matter, to achieve the right result, and to keep costs to a minimum. Archer is an expert with
identifying claim trends and fraudulent activity.
Prior to joining Mills & Reeve, Archer spent 16 years at DAC Beachcroft specialising in high value and catastrophic
injury claims—particularly those arising as a result of road traffic, accidents, and involving indemnity issues.
BILL MAHON
Bill Mahon is President of The MAHON Consulting Group LLC (MCG), where he specializes
in health care fraud management and prevention strategies/services for private and
public health insurance payers, law enforcement agencies, the health care professions
and health industry organizations.
Mr. Mahon was the executive director and later president/CEO of the National Health Care Anti-Fraud
Association, he also served as a journalist in finance and health care.
Paul Mewett
Paul Mewett is the Head of Internet Intelligence at Grant Thornton.
Mewett’s recent projects include: data mining and analysis of social media content—frequently within
a broader context of brand and intellectual property abuse, due diligence, cyber-terrorism, extremists
monitoring, or asset tracing.
Mewett has over 30 years of experience in the evaluation and implementation of new technologies for large
corporations, governments, and law enforcement agencies worldwide. This has included the use of state-ofthe-art search technologies and complex data mining tools; an area in which he is recognised as an expert.
Kirstyn Shaw
Dr. Kirstyn Shaw is the Employer Liaison Advisor for the South Central region at the
General Medical Council (GMC).
Her role is to support and advise Medical Directors and Responsible Officers on fitness to practise concerns,
GMC investigations, and revalidation recommendations. Previously, she worked as the Head of Revalidation
Policy with the GMC.
The GMC is the independent regulator for doctors in the UK. Its statutory purpose is to protect, promote,
and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.
Prior to joining the GMC, Shaw worked in revalidation policy and project management at the Academy of
Medical Royal Colleges and the Royal College of Physicians.
Di Hendry
After qualifying as a chartered accountant Di worked in the healthcare sector for over 20
years before setting up her own management consultancy business.
During a long career with BMI, the acute care division of General Healthcare Group, Di’s financial and
commercial experience in the fields of audit, pricing and acquisitions was extensive. As Commercial Director
her responsibilities included the formulation of pricing strategy and management of relationships and
contracts with the private medical insurers.
In 2010 she formed Stoneleigh Consulting, providing expertise and advice on strategy, business development,
pricing and relationship management to the private health, NHS and charitable sectors. Di joins Monmouth
following our recent agreement to acquire Stoneleigh Consulting.
Andrew Lawrence
Andrew has worked in healthcare since 1994, first as a consultant before becoming a
successful entrepreneur and seasoned Managing Director.
In 2002, he founded Westhill Consulting, leading it from start-up to sale to Tribal Group plc in November 2008.
He consolidated and integrated Tribal’s disparate health service capabilities, assuming full responsibility for
all Tribal’s health services businesses in August 2010.
He then successfully turned around a series of faltering major contracts whilst maintaining profitability,
despite prolonged market retrenchment and uncertainty. Following Capita plc’s acquisition of Tribal’s
consulting businesses in April 2011, Andrew led Capita’s commissioning and clinical support business until
December 2012 when he left to found Monmouth.
12
HICFG AWARD WINNERS
HICFG Award Nominations
Award Winners
Nominee
Company
Cash Plan Investigator of the Year
Paul Glover
Lousie Silke
SimplyHealth
SimplyHealth
PMI Investigator of the Year
Sophie Scruse
Sam Haycock
Sam Denyer
Richard West
SimplyHealth
Axappp
Axa ppp
Axa ppp
International Health Insurance Ann Adams
Investigator of the Year
Steve Knox
CIGNA International
Interglobal
Best New Comer
Ann Adams
Philip Gray
April Davies
Ella Burrows
Tom Lavelle
Emma Crutwell
CIGNA International
SimplyHealth
SimplyHealth
Interglobal
BUPA International
BUPA International
PMI Investigation Company of the Year
To Be Announced
IPMI Investigation Company of the Year
To Be Announced
Cash Plan Investigation Company
of the Year
To Be Announced
PMI Investigator of the Year
To Be Announced
IPMI Investigator of the Year
To Be Announced
Cash Plan Investigator of the year
To Be Announced
Industry Achievement AwardJim Stedall
Interglobal
Mostafa Shahein AXA International
Caroline Heneghan BUPA
HICFG Best Newcomer
To Be Announced
HICFG Personality of the Year Jim Stedall
Scott Doyle Award
Paul Francis
HICFG Personality of
the Year
To Be Announced
Interglobal
AXA
PMI Investigation Company All HICFG Member Companies
of the Year
Cash Plan Investigation
Company of the Year
All HICFG Member Companies
Intl Private Medical Insurance All HICFG Member Companies
Company of the Year
HICFG Investigator
All of the investigators nominated for
of the Year2013 awards are eligible and were
considered for this, the major award
of the conference. Industry Achievement Award
To Be Announced
HICFG Investigator of
the Year
To be announced
13
HICFG Member Companies
HICFG Vendor Associate Members
HICFG Conference Sponsors
14
structure and Mission of
thE HICFG
The Hicfg consists of member, associate
member and vendor member companies.
Member and associate member companies consist
of health related insurers, public health organisations,
NHS protect local counter fraud specialists or third
party health care administrators.
•Vendor members consist of companies that
supply specialist products and services to the
health industry.
•Full member and associate members pay
different annual fees and have different voting and
steering rights.
What are the rules of the group?
•The Hicfg is governed by a set of rules.
•These rules are clearly outlined in the policy and
procedure,code of conduct and participating
agreement documents.
•The HICFG steering committee are the custodian
of the governance documents. Copies can be
obtained by emailing enquiries@hicfg.com
•The HICFG Health Fraud Hub, HIFID database
and FIM are registered with the Information
Commissioners Office.
•All HICFG intelligence sharing software have
undergone legal review and opinion.
Who makes the decisions for the HICFG?
•The HICFG Steering committee votes on decisions
and direction. The steering committee sets a
strategy for the year.
•The Chair is elected by the steering group.
The Chairs role is to lead the steering committee
in strategy and direction.
•A deputy chair is selected by the Chair.
•The treasurer ensures funds are managed
appropriately.
•The Association of British Insurers manage
HICFG banking.
•The Director forms a part of a contracted agreement
to provide technical support to the Hicfg.
•The steering committee meets quarterly to plan
and act on behalf of the entire membership.
15
4 simple STEPS to share and use
HICFG intelligence - Identify-Add-Alert-Prevent
Step
01
Identify
You identify a suspected fraudulent
claim or bill.
Add
Step
Add the details of the fraudulent claim or bill to the
HIFID database. You can access HIFID via the health
fraud hub ‘case database’ tab.
02
HIFID will identify if the subject has previously
been entered by another company.
Link cases involving the same subjects.
Step
03
Alert
Issue an alert on the Health Fraud Hub
Investigation Forum to Prevent other companies
from being defrauded.
Prevent
Integrate HIFID data against your own billing, new
business and claims data to prevent loss in real time using
the Fraud Intelligence Manager (FIM).
Step
04
@hicfg_enquries
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throughout the conference using: #hicfg