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  • Wednesday, June 26 | 8:30–9:45 AM


    CPE: 1.5

    Level: Intermediate

    Recommended Prerequisites: None

    Field of Study: Specialized Knowledge

    Through the examination of large-scale laboratory kickback schemes, this session will discuss the Federal Anti-Kickback Statute, methods of investigation using public records and health plan data, and potential case outcomes. The case study involves an investigation of several national laboratories who had allegedly engaged in schemes to increase patient referrals by offering payments to physicians and practitioners on a per-specimen basis for lab tests that may not have been medically necessary. The investigation found evidence that more than 2,000 physicians and practitioners across the country received these alleged improper payments. The investigation also identified other issues in medical records, exposing system-wide risks and leading to potential recoveries.

    You Will Learn How To:

    • Compare kickback schemes involving diagnostic laboratories and physicians/practitioners
    • Identify public records and resources for use in health care fraud investigations
    • Identify documentation requirements for laboratory services and common findings
    • Recognize objectives for health care fraud investigations from multiple perspectives (health plan versus law enforcement)
    • Ascertain how to apply investigative findings to system-wide risk

    Daniel McManus, M.S., CFE, CPC-A

    Senior Investigator, Premera Blue Cross

    Daniel McManus is a senior investigator for Premera Blue Cross. McManus has ten years of experience working in investigative and oversight positions in Medicaid, Medicare and commercial health plans. He has led investigations into fraudulent billing, illegal kickbacks, physical abuse, improper prescribing and computer crimes. His cases have resulted in criminal investigations, multiple convictions and regulatory sanctions. McManus is a Certified Fraud Examiner and Certified Professional Coder. He holds bachelor’s degrees in psychology and criminology from the University of Florida and a master’s degree in economic crime management from Utica College.

  • Daniel McManus, M.S., CFE, CPC-A

    Senior Investigator, Premera Blue Cross

    Daniel McManus is a senior investigator for Premera Blue Cross. McManus has ten years of experience working in investigative and oversight positions in Medicaid, Medicare and commercial health plans. He has led investigations into fraudulent billing, illegal kickbacks, physical abuse, improper prescribing and computer crimes. His cases have resulted in criminal investigations, multiple convictions and regulatory sanctions. McManus is a Certified Fraud Examiner and Certified Professional Coder. He holds bachelor’s degrees in psychology and criminology from the University of Florida and a master’s degree in economic crime management from Utica College.

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