Description: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.

Description: Digests of following discussions: 1. Mutual life insurance companies - their objectives and operating philosophy 2. State, provincial, and municipal employee pension plans - financing and other problems 3. Mortality and underwriting of individual policies for large amounts 4. Investing during the 1970's 5. Long-range viability and regulation of corporate pension plans 6. Forecasting the environment for business 7. Liabilities and surplus in the 1970's 8. Changing modes of family life - work and income over the life cycle 9. The role of the actuary in collective bargaining 10. Health insurance in the United States 11. Adjusted earnings

Description: Discusses cost-benefit decision-making for acquiring electronic data-processing equipment and installation issues, ability of small companies to compete in pension trust arena, effectiveness of various agency compensation programs in stimulating sales and improving persistency, success of sales to substandard risks and rating methods, and pricing, reinsurance and experience with individual hospital and medical policies.

Description: Presented at October 1985 Annual Meeting. This session discussion is about trends in utilization review 'UR', preadmission certification, concurrent review, discharge planning, retrospective review, considerations in the design or purchase of UR services, normative data and monitoring UR, recent experience of UR programs and future expectations.

Description: This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment from providers who meet higher quality and cost-effectiveness standards.

Description: Presented at October 2001 Annual Meeting. Panelists provide insight into the factors driving the cost increase of prescription drugs and how these factors are being addressed. Strategies include drug utilization review, manufacturer contracting, benefit design, formularies, pharmaceutical pricing, therapeutic substitution, physical education, and introduction of new pharmaceuticals. Also discussed are pharmacoeconomic benefit considerations when studying integrated medical and pharmacy expenses.

Description: We highlight a new approach leveraging predictive analytics to identify high risk and rising risk opioid users for more effective screening and follow-up care.