NHCAA Institute for Health Care Fraud Prevention

Anti-Fraud Expo, October 15-17, 2019 in Nashville, TN


Location:

Music City Center, 201 Fifth Ave.
South, Nashville, TN 37203,
Tel. 615-401-1400.

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Conduent Speaking Session

Case Study:  Integrating Clinical and Pharmacy Audits to Solve Complex Fraud

Join a pharmacy practice subject matter expert from Conduent for a case study discussion of how a pharmacy audit lead to a wider discovery of diversion and suspected fraud, waste, and abuse. Walk through the case as pharmacy practice, clinical assessment, and FWA analysis ultimately uncovered a greater issue than one misfill. Learn from this case how a seed can grow into something unexpected and that expectations can lead to incorrect conclusions.

Featuring: Joshua Peters, PharmD, RPH; Client Manager and FWA Lead Auditor, Conduent Commercial Healthcare

Location: Conduent Speaking Session is from 2:45 – 3:45 pm on Wednesday, October 16, 2019 (2nd floor – Room 207CD)

 

Joshua Peters, PharmD, RPh, is a 2003 graduate of the University of Rhode Island, College of Pharmacy. He has been a member of Conduent Clinical Outcomes Services for the past 7 years concentrating on the detection and recovery of pharmacy claims arising from fraud, waste and abuse. Additionally he has been the client manager to a Fortune 100 health plan’s vended pharmacy audit program for 3 plus years. In that time he has overseen the expansion of the audit program into desk audits, invoice audits and credentialing visits to supplement field audits conducted nationally. Prior to joining Conduent he worked in retail pharmacy for over 16 years with experience in both independent and chain pharmacies. Josh leverages his professional experience and auditing expertise to improve pharmacy network compliance and program integrity activities for all Clinical Outcomes Services clients in his capacity as the group’s pharmacy practice and FWA subject matter expert.