Description: The presenters will provide insights into fraud and abuse risk in the health insurance industry, including an examination of traditional and predictive modeling techniques for both prevention and detection. Emphasis will be placed on current and emerging risks. Canadian examples and perspectives will be offered, but the applications for attendees to use in practice are non-nation specific.

Description: This article is an update on the No Surprises Act, which is a U.S. Act aimed to reduce the risk that a person unexpectedly receives out of network charges for their health care visits.

Description: This session will examine bias from a social science perspective. It will discuss the three types of systemic biases using the National Institute of Standards and Technology (NIST) model. The NIST model details the three types as historical bias, societal bias, and institutionalbias. The session will also provide several examples of each type to provide a framework for identifying the social structure of bias.

Description: Discuss various analytics and use cases using payer published reimbursement contract data under federal mandate of Transparency in Coverage. These contract rates are publicly available in machine readable format (MRF) starting July 1, 2022, and refreshed monthly. By attending the session, you will have a better understanding of the state-of-art development and analytics using MRF data, including the technologies used to extract and analyze huge MRF files, validation and limitations of published rates, and their use cases.

Description: "Discuss research conducted at the Cleveland Clinic to understand levels of anxiety and depression across Northeast Ohio. Specifically, learn how advanced analytical techniques were utilized with social media data from Twitter and Google to estimate the need for psychological support by geography and overtime. The panel will go further to demonstrate how natural language processing (NLP) and machine learning could be used to make operational decisions at a leading health care provider."

Description: The Inflation Reduction Act represents the most significant changes to the Part D program since its inception 20 years ago. The implications will not only alter the benefits offered by Medicare Advantage (MAPD) and Prescription Drug Plans (PDP) but will alter the Part D cash flows and the seasonality of such amounts for interim reporting periods. In this session, we will provide a brief overview of the IRA changes and dive into how the changes could impact the 2008 Medicare Part D Accounting Practice Note.

Description: Explore a brief overview of federal income taxation of health insurers and selected technical tax topics during this panel discussion webcast. You'll dive into the evolution of heath insurers and healthcare-related services and the arising questions regarding their risk-bearing activities, as well as whether or not certain types of healthcare businesses qualify as "insurance companies" for federal income tax purposes. Also, expect to learn about loss reserves for guaranteed renewable contracts and how they can affect insurance company tax status. This webcast will continue to highlight how the IRS challenges loss reserves of health insurers as the panelists review the status of tax cases, IRS guidance and recent IRS activity regarding "margins."

Description: The presenters will discuss predictive analytics as applied to recent group life and disability experience studies and other applications.

Description: Discussion of the standards set by ASOP 23 on data quality within a health insurance context.

Description: This report examines lapse experience on individual disability income insurance products by various policyholder and product factors. The study can be used for industry benchmarking as well as for background information for product development and planning purposes.