2014 HICFG Training ConferenceThe Bull, Gerrards Cross Buckinghamshire

03 Conference Venue Information

04 Welcome from Dawn Brockman, HICFG Chairperson

05 Historical Review of HICFG

06 Raymond Collins, HICFG Technical Directors Report

07 Conference Schedule

08 Networking Opportunities

09 Master of Ceremonies, Ted Doyle, Biography

10 Conference Speaker Biographies

11 HICFG Award Winners

12 HICFG Member Companies & Sponsors

13 Delegate list

14 Structure and Mission of the HICFG

15 4 Simple Steps to Share and Use HICFG Intelligence

CONTENTS WELCOME

THE BULL

Welcome to the 2014 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.

Situated in Gerrards Cross, The Bull is a four star hotel of intimate

charm. Originally built as a coaching inn on the old main road

from London to Oxford, its current interior is a mixture of

contemporary and traditional elements.

Overlooking the picturesque village common in Gerrards Cross,

The Bull offers traditional charm and unprecedented service. With

beautifully manicured gardens, an award-winning restaurant

and comfortable lounge, as well as a traditional pub specialising

in fine local ales.

The Bull Hotel, Oxford Road, Gerrards Cross, Buckinghamshire SL9

T: 01753 885995

F: 01753 885504

E: bull@sarova.com

W: sarova.com

CONFERENCE VENUE INFORMATION03

UPON ARRIVAL

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.

ROOM AMENITIES

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.

Phone calls are charged at a hotel rate. These charges will be

added to your room bill at the end of your visit.

Laundry service is also available to all The Bull 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

Nuffield Health Fitness & Wellbeing Centre in Stoke Poges offers

guests discounted use of a swimming pool and gym.

AFTER THE CONFERENCE

The Bull check out time is 11:00am.

FACILITIES

Restaurant

Breakfast (Buffet) - 7:00am – 9:30am

Lunch (Buffet) - 12:30pm – 2:00pm Dinner (Plated) - 7:00pm – 9:00pm

Bar

Wednesday/Thursday - 5:00pm – Late Friday - 12:00pm - Midnight

(Bar snacks are available up until 10:00pm)

WELCOME FROM DAWN BROCKMAN, HICFG CHAIRPERSON

04

I would like to welcome you to the 2014 HICFG Annual Training

Conference.

For 14 years, this association has served as a not for profit group with an

interest to increase awareness, improve and promote the detection,

investigation, and prevention of health care fraud and abuse.

This year has been exciting in terms of growth for the group. We

welcome new members who provide services within the public

healthcare sector and new private insurers to the group. This will

provide opportunities to work collectively and holistically at sharing

best practice, methodologies and technology that will help prevent

fraud, abuse and waste within the industry and across the public

healthcare sector. HICFG also welcomes International members as it

becomes more apparent that fraud has no geographical boundaries.

With record figures relating to healthcare fraud, waste and abuse

being published, there is greater focus from companies, regulators

and ultimately the general public to deal with fraud.  This year’s

training conference sees a great variety of speakers and subject

matter experts and I would recommend this should be used as

an opportunity to form networks and ultimately friends, who

can support and assist in what can sometimes be a hostile and

unforgiving environment to work in.

Thank you for your continued support and I hope that you enjoy

this year’s event

Regards,

Dawn Brockman HICFG Chair – Bupa Global

RAYMOND COLLINS, HICFG DIRECTORS REPORT

06

Welcome to the 2014 Health Insurance Counter Fraud Group (HICFG) Annual Training Conference (ATC).

I would like to welcome our new members: Freedom, Medibank

International, Tiaa and the Global Benefits Group, You are welcome

additions to the Association. We look forward to seeing and hearing

about your companies 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, Dawn Brockman, Treasurer, Dr Simon

Peck, Legal Andrew Roberts and Governance Jim Steddall for

another outstanding year and for providing an organised anti fraud

association to the health insurance member companies that we

serve. Dawn has been a ball of energy over the past year, creating

and driving new initiatives, enhancing the groups structure and

promoting the value of membership both in the UK and abroad.

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 CollinsDirector

HISTORICAL REVIEW OF HICFG05

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) Counter-

Fraud 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.

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.

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 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 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 2012, the HICFG successfully hosted the second

annual Global Health Care Anti-Fraud Network

summit. It included 220 delegates from 23 different

countries. In 2014 The HICFG became an independent

trade assosciation after having spent a large part

of its existence under the umbrella of the ABI. The

membership grew with the introduction of four

new members. If your company is interested in

membership or associate membership with the Health

Insurance Counter Fraud Group, please contact us at:

www.hicfg.com.

HICFG DIRECTORS REPORT HICFG DIRECTORS REPORT06 (cont) 06 (cont)

The HICFG 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 2014 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 21,000

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 21,000 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.

Training has gone from strength to strength. The HICFG

provides training courses for its members ensuring

the highest levels of skill and professionalism exist

within the industry. Accreditation is in line with NHS

Protect. IMT can 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.

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

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 Durban, South Africa.

The HICFG increased its membership in 2014 with

the induction of Tiaa, Medicare International and The

Global Benefits Group. Tiaa joins Baker Tilly being the

largest third-party provider of counter fraud services to

the NHS.

IN 2015 THE HICFG MEMBERSHIP WILL CONSIST OF

40 COMPANIES.

IN 2012 THE HICFG SUCCESSFULLY HOSTED THE GLOBAL HEALTH CARE ANTI FRAUD

NETWORK ANNUAL SUMMIT WHICH INCLUDED

220 DELEGATES FROM

DIFFERENT COUNTRIES

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

IN 2013 THE HICFG HEALTH INTELLIGENCE FRAUD INVESTIGATION DATABASE CURRENTLY HOLDS AROUND

NAMES OF HIGH RISK BILLERS AND CLAIMERS22,000

300OVER23

HICFG

IN NU

MBER

S

CONFERENCE SCHEDULE07

THURSDAY 16TH OCTOBER

0730 - 0850 Registration - Coffee and tea for delegates in the vendor exhibit area

0900 - 0915 Welcome - Conference opening and welcome by MC Ted Doyle

0915 - 0945 Paul Montgomery & Andrew Townsend of Tiaa - NHS counter fraud and the overlap with private insurance

0945 - 1015 Neil Smith - Accessing information from social media

1015 - 1030 Coffee Break - Vendor exhibit area

1030 - 1115 Dr Raj Mallipedi - Dermatology

1115 - 1200 Joel Alleyne of Canadian Health Care Anti Fraud Association - Setting up a health insurance special investigation unit (SIU)

1200 - 1330 Lunch - Buffet lunch to be served in the main dining room

1330 - 1400 Gary Sommerford of IMT - IPMI case study “A Greek Tragedy”

1400 - 1430 Dr Peter Wilmhurst - NHS fraud and whistle blowing

1430 - 1445 Coffee Break - Vendor Exhibit Area

1445 - 1530 Kate Archer & Carole Chantler of DWF Solicitors - Insurance claims fraud

1530 - 1600 NHS Counter Fraud Services Panel including Jon Gladwin of Tiaa, David Foley of Baker Tilly and Gary Somerford moderated by Ray Collins - The use of third party consortiums to counter fraud and undertake audits within the NHS

1600 - 1630 Det Insp David Wood of IFED - Cash plan and pmi case study “Back Star”

1630 - 1700 Leo Reynolds - Portsmouth University Accredited Counter Fraud Specialist training courses for the HICFG

1700 - 1830 Vendor Cheese & Wine - Delegates are invited to attend the vendor cheese and wine reception. A prize draw will be held

2000 - until late Networking Awards Dinner - Dinner and music featuring the house DJ Followed by Karaoke!

FRIDAY 17TH OCTOBER

0930 - 1030 Lisa Davis of the General Optical Council - An overview of the GOC, discipline hearings and sanctions

1030 - 1100 Coffee Break Vendor exhibit area

1100 - 1200 Jonathan Green, Katie Spears and Richard Dancy of the General Dental Council - An overview of the GDC, regulation, investigation and illegal practice

1200 - 1230 Ted Doyle of Performant Europe - Payment integrity software demonstration and its application to prevent fraud, waste and abuse in real time claims and billing

1230 – 1245 Close of Conference - Ray Collins introduces the HICFG chair Dawn Brockman

THURSDAY 16TH OCTOBER

1200 - 1330 Luncheon - Delegates are invited to enjoy hot and cold lunches in the main dining room

1700 - 1830 Vendor Wine Tasting - Delegates are invited to attend a wine tasting reception in the vendor exhibit area - just outside of the main conference room. Note: a prize draw will be held! Sponsored by Performant Europe!!!!

2000 - 2020 HICFG Investigator of the Year Awards

2000 - until late Networking Dinner - Delegates are invited to attend a networking dinner featuring the Bulls resident DJ Dress code - Lounge suits for the men and cocktail dresses for the ladies

Until later Karaoke - Delegates are invited to participate in karaoke

FRIDAY 17TH OCTOBER

1215 - 1300 Luncheon - Delegates are invited to enjoy hot and cold lunches in the main dining room

NETWORKING OPPORTUNITIES08

MASTER OF CEREMONIES, TED DOYLE, BIOGRAPHY

09CONFERENCE SPEAKER BIOGRAPHIES

10

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.

KATE ARCHER

Archer has worked as a Partner at some of the UK’s largest law firms and has spent the last 18 years working for insurance companies defending compensation claims involving injuries of the utmost severity.

She has spent the last two years researching and developing counter-fraud products for

the healthcare sector, and since joining DWF earlier this year has been working closely

with their long-established healthcare team led by Michael Boyd, to raise awareness of

the scale of fraud and error risk to both public and private sectors.

DR PETER WILMHURST

Dr Wilmshurst, a consultant cardiologist, has spent the last two decades trying to expose research misconduct and has reported more than twenty doctors to the General Medical Council.

In recognition of his dogged and selfless pursuit of the truth, Dr Wilmshurst was

presented with the HealthWatch Award 2003.

PAUL MONTGOMERY

Montgomery’s career has seen him work for Arthur Andersen and lead a team undertaking NHS external audit appointments in the Midlands. Montgomery then joined KPMG, where he was given responsibility for a mixed portfolio of external and internal audits and gained exposure managing and delivering advisory work to a range of public sector clients, but predominantly in the health sector.

Montgomery later joined NHS Supply Chain, as Head of Audit and Risk Management, he later

worked as the Head of Audit and Risk Management for the NHS Business Services Authority, a body responsible

for the management of Prescription Pricing, Payments to NHS Dentists, NHS Protect (counter fraud), the NHS

Pension Scheme (the largest in Europe), and the Supply Chain contract with DHL.

Over the last four years Montgomery has been leading large NHS internal audit consortia, where again the

management of change has been a vital component, and which has culminated in the successful spin-off of

the former Parkhill consortium into a more appropriate setting through the merger with Tiaa.

DAVID FOLEY

Foley is an experienced financial crime, fraud & bribery practitioner, who is an accredited counter fraud specialist and financial investigator.

Foley leads Baker Tilly’s Fraud Risk Services team, part of its Risk Advisory Service Line, in

providing a full range of counter fraud & bribery services to a wide range of clients across

many sectors, both within the UK and overseas.

Foley has played lead roles in projects involving complex financial fraud investigations,

within the UK and across multiple foreign jurisdictions, with a proven track record in

applying sanctions and assisting organisations recover their fraud losses.

JON GLADWIN

Gladwin joined the NHS in 2006 having previously served in the Military, Police and with local government. He has expertise in specialist investigation, security and intelligence.

An Accredited Counter Fraud Manager, Gladwin was formally in-charge of the Fraud

Investigation Unit for a large unitary authority in the South of England and has enjoyed

an extensive Public Sector career, including more recently, service as a Specialist Advisor

for the United States DoD in the Middle East.

Gladwin leads Tiaa’s intelligence and data services team as well as managing a dedicated team of counter

fraud specialists.

ANDREW TOWNSEND

Townsend is a qualified accountant and internal auditor with over 37 years’ experience covering all aspects of public sector internal audit. Andrew set up and developed Tiaa and is our managing director.

As Managing Director, Townsend is responsible for the running and the strategic direction

of Tiaa. He is an experienced professional internal audit director with a well-developed

team and project management experience.

Townsend has experience working in public sector organisations both employed and as

an external consultant providing internal audit support to in-house audit teams. He has carried out a wide

range of key assignments in a broad range of areas including, fraud investigations, risk management and

corporate governance.

Townsend has helped streamline a number of key governance systems within his clients to ensure the

processes are effective and efficient. In addition he has provided training and guidance on risk management

to a number of boards and training to audit committees to improve their effectiveness and thus the overall

governance framework of their organisations.

CONFERENCE SPEAKER BIOGRAPHIES

10(cont)

DAVID WOOD

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.

NEIL SMITH

Smith is an Investigative Researcher & Trainer, specialising in open source intelligence techniques.

Smith served 10 years as a police officer in a major UK police force. He has also worked

as a counter-fraud specialist for a government department and as a fraud investigator for

insurance companies.

CONFERENCE SPEAKER BIOGRAPHIES

10(cont)

RICHARD DANCY

Dancy joined the Metropolitan Police in 1981, and had numerous roles until he retired at the end of 2013. Dancy has been an investigator with the illegal practice team at the GDC since January 2014.

Dancy started his career as a beat officer working at various police stations across south east

London. During his law enforcement career Dancy worked the CID where he investigated

major crimes, including murder cases and serious assaults, theft of credit cards robberies,

assaults and public riots.

KATIE SPEARS

Spears joined the General Dental Council in February 2014, and is a lawyer in the Illegal Practice team. Spears is responsible for the oversight and investigation of cases and the prosecution of incidences of the illegal practice of dentistry, and other associated offences. Spears is experienced in the investigation and prosecution of offences under the Dentists Act 1984.

Spears qualified as a barrister and came to the Bar in 2005. She has previously conducted

a review of the Anti-Money Laundering and Countering of the Financing of Terrorism statutory and regulatory

compliance for a large financial institution. She has worked on cases involving large scale fraud, organised crime

and drug offences, serious violence and sexual crime, trademark offences and civil hearings, amongst others.

JONATHAN GREEN

Green qualified as a solicitor in 1994 and is the Head of the In-house Legal Prosecutions Team at the General Dental Council (GDC). He joined the GDC in 2013 having worked as a medical lawyer in private practice and the Royal College of Nursing.

In private practice, Green specialised in clinical negligence, public law and medical ethics

cases. He was one of the three solicitors who conducted the Alder Hey Organ Retention

case (which remains one of the largest mediated medical cases in England and Wales) and

secured changes to the v.CJD Compensation scheme after bringing a judicial review against the government.

Green now leads a team of 18 as part of the GDC’s new In-house Legal prosecutions Team.

DR RAJ MALLIPEDDI

Dr Mallipeddi qualified from Imperial College School of Medicine and completed specialist dermatology training at St John’s Institute of Dermatology, St Thomas’ Hospital London.

Dr Mallipeddi spent over two years undertaking laboratory research within the Genetic

Skin Disease Group at St John’s Institute of Dermatology, finally being awarded a Doctor of

Medicine degree for the study of squamous cell carcinoma in epidermolysis bullosa.

GARY SOMMERFORD

Sommerford is an independent consultant providing counter fraud, risk and investigative solutions for the insurance industry.

Sommerford has over 28 years experience in investigation and training having worked in

HM forces, NHS Counter Fraud and for private health insurers. He is Accredited Counter

Fraud Specialist (ACFS and previous winner of the HICFG Investigator of the year award.

CAROL CHANTLER

Chantler is the Director of Clinical Services for DWF. She has over 15 years experience in case management both in the UK and Canada, as well as over 20 years experience in trauma, neurological and cardiovascular intensive care nursing.

Chantler, as part of DWF’s Insurance team, Carole works alongside insurers, lawyers,

claimants and their families to promote good practice in rehabilitation and disability

management, and to try to ensure a positive return on investment and conclusive

outcomes for all parties.

Chantler obtained her Masters in Case Management Health and Employment, the first degree of its kind in the UK.

In 2011 Carole won the Post Magazine Individual Outstanding Achievement Award for her work in rehabilitation.

JOEL ALLEYNE

Alleyne is the Executive Director for the Canadian Health Care Anti-fraud Association (CHCAA). He has worked with management in several organisations. His career has included work with Senior

Executives on Business and Organisational Strategy as well as Strategic Information and

Technology Planning.

Alleyne has worked in the insurance and healthcare industries in Canada and the United

States. He has been involved with Canadian initiatives to implement and leverage

electronic commerce and new media as well as the development of commercial claims systems products.

CONFERENCE SPEAKER BIOGRAPHIES

10(cont)

LISA DAVIS

Davis is the Head of Fitness to Practise at the General Optical Council (GOC). Her role is to have oversight and responsibility for the end to end process – from complaint through to investigation, adjudication and appeal – in respect of fitness to practise allegations.

Prior to joining the GOC, Davis worked within fitness to practise at the General

Pharmaceutical Council (GPhC) first as an Advocate and then as Case Progression Manager.

LEO REYNOLDS

Reynolds has run and helped to run various businesses over the last 20 years in a variety of different industries. In 2012 he worked as a director for a training company delivering the ACFS course. During this time Leo sat on both the Tech and Executive committees of the CFPAB and also spoke at the 7th Health Insurance Asia Conference 2013

Reynolds currently works as an independent Fraud Investigator, whilst pursuing a Masters

degree In Counter Fraud and Counter Corruption.

Reynolds recently developed a Full ACFS course bespoke for the Health insurance Industry which has

recently been accredited by the University Of Portsmouth.

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HICFG AWARD WINNERS11

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IPMI Investigator of the Year STEVE KNOX INTERGLOBAL

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IPMI Investigation Company of the year AXA INTERNATIONAL & INTERGLOBAL

PMI Investigation Company of the year AVIVA

Lifetime Industry Achievement Award JO LUMB CS HEALTHCARE

HICFG Personality of the Year - Scott Doyle Award PAUL FRANCIS AXA PPP

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We can provide you with investigative case management support to assist you to manage the process and securely deliver the evidence.

We help you prevent loss and save your company money.

We provide you with a flexible integrated approach to third party investigation.

We can provide an investigator to work in house with your investigation team.

COST A fixed daily rate

Fixed costs for international investigations

CONTACT IMT InvestigationsPhone: +44 (0) 20 8133 7322

DELEGATE LIST13

Sara Rawlings AvivaSimon Waters AvivaDeb Turton AvivaSarah Rejcht AvivaVailij Nevlev AvivaBrenda Swaddling Axa pppSimon Peck Axa pppPaul Francis Axa pppSamantha Haycock Axa pppTracy Domminney Axa pppRichard West Axa pppSam Denyer Axa pppClaire Hall Axa pppGeorge Paxton Axa pppJemma Vockins Axa pppSally Felton Baker TillyDavid Foley Baker TillyMike Tresham BHSFMatthew Wickstead BupaCaroline Heneghan BupaVicky Hallewell BupaJames Forsyth BupaBernie Concannon - Burke Bupa Nalini Rangesh Bupa Amy Dhanjal Bupa Dr.Karim Saad Salib Abdelnour Bupa ArabiaSteve Marsh Bupa GlobalDawn Brockman Bupa GlobalJoel Alleyne CHCAAHeather Foster CHCAASibylle Dow CignaAnita Gillespie CignaJane Chen CignaTrevor Bedeman CignaAnn Adams Cigna Neil Smith ConsultantPeter Wilmhurst ConsultantArno Dondi CS Health CareJo Lumb CS Health CareDavid Coy CS Health CareDr Raj Mallipedi DermatologistKate Archer DWFCarole Chantler DWFStephen Chaloner Freedom HealthJon Green GDC

Katie Spears GDCRichard Dancy GDCLisa Davis GOCDonna Thompson Health OnlineDavid Wood IFEDRay Collins IMTGary Sommerford IMT - InvestigationsLeo Reynolds IMT - Training Ashley Porter IMT Event ManagerKatie Jane Clark IMT Event Staff Steve Knox InterglobalJim Stedall InterglobalSimon Winnard KeoghsMarj Murphy MedicashIan Clark MODDi Hendry Monmouth PartnersSaranjit Nagra PaycareTed Doyle Performant - MCSimeon Kohl PerformantChris Dark PruHealthAndrew Roberts PruHealthSamantha Chequer PruHealthMandy Hobbs PruHealthDebra Mills PruHealthColin Weston RGACheryl Windslade Simply HealthLisane Harris Simply HealthKirk Hambrook Simply HealthApril Davies Simply HealthMelanie Alflatt TiaaLorraine Bennett TiaaJohn Butler TiaaJon Gladwin TiaaSarah Kabirat TiaaPaul Montgomery TiaaWilliam Simpson TiaaAndrei Tinine TiaaAndrew Townsend TiaaSteffan Wilkinson TiaaDanny Boles VHIJohn Murphy VHIJulie Gill Westfield HealthSheree Osborne Westfield HealthNeil Davidson WPAJoy Ware WPA

Guest Company Guest Company

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.

• Membership fees are paid directly to IMT as a part

of a licensing agreement.

• The Director forms apart 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.

STRUCTURE AND MISSION OF THE HICFG

14

4 SIMPLE STEPS TO SHARE AND USE HICFG INTELLIGENCE - Identify-Add-Alert-Prevent

15

IdentifyYou identify a suspected fraudulentclaim or bill.

Step

01

AddStep

02Add the details of the fraudulent claim or bill to the HIFID database. You can access HIFID via the healthfraud hub ‘case database’ tab.

HIFID will identify if the subject has previously been entered by another company. Link cases involving the same subjects.

AlertIssue an alert on the Health Fraud Hub Investigation Forum to Prevent other companiesfrom being defrauded.

Step

03

PreventStep

04Integrate HIFID data against your own billing, newbusiness and claims data to prevent loss in real time using the Fraud Intelligence Manager (FIM).

NOTES

2014 HICFG Training ConferenceThe Bull, Gerrards Cross Buckinghamshire

@hicfg_enquries Please feel free to tweet pictures and comments throughout the conference using: #hicfg

Join us on Linkedin (search Linkedin groups for) Health Insurance Counter Fraud Group HICFG Annual Training Conference