Wayne van Halem
PresidentThe van Halem GroupWayne van Halem founded The van Halem Group in 2006. The Atlanta-based firm merged with VGM Group in 2014 and Wayne currently serves as its President as they assist providers navigate complex issues related to audits, appeals, enrollment, and compliance. As a CMS contractor for 10 years, he spent a majority of that time as a fraud investigator and national Appeals Director. Wayne is also a published author and well-known lecturer. He is an Accredited Healthcare Fraud Investigator through the National Health Care Anti-fraud Association (NHCAA); a Certified Fraud Examiner through the Association of Certified Fraud Examiners (ACFE), and an active member of the Health Care Compliance Association (HCCA). He has served on the faculty for each of these national organizations. He also sits on the American Association for Homecare’s Regulatory Council, Medtrade’s Educational Advisory Board, Medicare DME MAC Jurisdiction D Advisory Council, and Board of Directors for Friends of Disabled Adults and Children (FODAC) and the Georgia Association of Medical Equipment Suppliers (GAMES). He has also served as an expert in various criminal and civil proceedings. Since 2006, his company has saved clients over $150 million in overpayments and denial recoveries.
AU04: Uses and Abuses of Extrapolation and AI Software by Payors and CMS
Joint presentation with Wayne van Halem and Stephen Bittinger regarding current litigation and compliance regarding the use of statistical sampling an…Joint presentation with Wayne van Halem and Stephen Bittinger regarding current litigation and compliance regarding the use of statistical sampling and extrapolation and AI software tools for auditing and claims review by payors and CMS. The presenta…Joint presentation with Wayne van Halem and Stephen Bittinger regarding current litigation and compliance regarding the use of statistical sampling and extrapolation and AI software tools for auditing and claims review by payors and CMS. The presentation will cover the law, regulation, and guidance, or lack thereof for AI, that suppliers should know in using AI software tools, self-auditing with statistical sampling and extrapolation, and how to challenge both when used by payors or CMS. The presentation will also cover current litigation against payors for use and abuse of AI and extrapolation and DOJ investigations of use and abuse of AI by providers and suppliers. Show MoreClick the title to see all details
AU06: Audit Landscape: What’s New, Now, Next?
This presentation will provide a comprehensive overview of the current audit landscape, including current trends with federal, state, and commercial p…This presentation will provide a comprehensive overview of the current audit landscape, including current trends with federal, state, and commercial payers. Additionally, as new leadership at HHS and CMS has settled in to their roles, what insight ha…This presentation will provide a comprehensive overview of the current audit landscape, including current trends with federal, state, and commercial payers. Additionally, as new leadership at HHS and CMS has settled in to their roles, what insight has been gained on how the agency will approach program integrity activities moving forward, including newly announced focus on fraud, waste, and abuse and the use of technology to aid in weeding it out. The presentation will also provide an understanding of what we might anticipate happening for the remainder of the year and beyond.Show MoreClick the title to see all details
CB02: Understanding the Bid Process
This session will walk attendees through the detailed requirements for submitting a bid in the next round of the Medicare competitive bidding program …This session will walk attendees through the detailed requirements for submitting a bid in the next round of the Medicare competitive bidding program (CBP). What are the requirements for submitting a bid, including what are bid bonds and how are they…This session will walk attendees through the detailed requirements for submitting a bid in the next round of the Medicare competitive bidding program (CBP). What are the requirements for submitting a bid, including what are bid bonds and how are they different than the current surety bonds? What financial documents will be required and how are they scored when determining whether a supplier is qualified to bid? How do commonly owned companies submit bids? How will CMS evaluate bids and select contract suppliers? Learning Objectives: Requirements that suppliers need to know and understand to participate in the next Medicare CBP, including: Basic prerequisites Bid bonds Financial document requirements Licensure requirements The bid evaluation process The contract selection processShow MoreClick the title to see all details
CB05: Understanding the Bid Process
This session will walk attendees through the detailed requirements for submitting a bid in the next round of the Medicare competitive bidding program …This session will walk attendees through the detailed requirements for submitting a bid in the next round of the Medicare competitive bidding program (CBP). What are the requirements for submitting a bid, including what are bid bonds and how are they…This session will walk attendees through the detailed requirements for submitting a bid in the next round of the Medicare competitive bidding program (CBP). What are the requirements for submitting a bid, including what are bid bonds and how are they different than the current surety bonds? What financial documents will be required and how are they scored when determining whether a supplier is qualified to bid? How do commonly owned companies submit bids? How will CMS evaluate bids and select contract suppliers? Learning Objectives: Requirements that suppliers need to know and understand to participate in the next Medicare CBP, including: Basic prerequisites Bid bonds Financial document requirements Licensure requirements The bid evaluation process The contract selection processShow MoreClick the title to see all details