An introduction to health care fraud, how much it costs US citizens, and strategies and solutions to minimize health care fraud.

1. Health Care Fraud Hurts! The Impact of Health Care Fraud, and What You Can Do To Fight Fraud within Your Organization February 2010 1

2. Agenda 2

3. Alpine Consulting Overview Technology Practices: Information Management e-Commerce 3

5. Fraud & abuse reporting

7. Medicaid provider fraud

9. Inappropriate / Unlawful Relationships

11. Transaction aggregation & disambiguation

13. Nevada State Gaming Board compliance

15. Medicaid Program Woes State: Medicaid Deficit ($ Millions) New York $ 548.1Illinois $ 379.3Ohio $ 281.2Pennsylvania $ 261.2New Jersey $ 241.9Texas $ 235.0California $ 203.6Wisconsin $ 200.0Massachusetts $ 197.0Florida $ 188.5 6

16. Ripe Environment for Fraud Opportunity Pressure Rationalization 7

17. Fraud, Waste, and Abuse Statistics Sources: Coalition Against Insurance Fraud. www.insurancefraud.org. 8

18. Fraud Opportunities“Where there’s smoke, there’s fraud” 9

19. Pressure to Commit Fraud 10

20. Fraud Rationalization 11

21. Failure to fight fraud 12

22. Fighting Fraud Effectively 13

23. Alpine JumpstartGet Started with our Fraud Data Assessment 14

24. Alpine Fraud Mitigation TechnologiesUsed within the Fraud Data Assessment Memento Security IBM Identity Insight 15

25. Memento Security 16

26. IBM Identity Insight 17 More info at: http://www-01.ibm.com/software/data/identity-insight-solutions/

27. 18 Case Study: Health Care Claims A Sample “Investigative Lead”: Entity #2580111 Providers: 70010000ZL4550 XXXX URGENT CARE LLC XXXX URGENTCARE 1735 XXXXX Ste 450 Okemos, MI 48864 1735 Hamilton Okemos,MI 48864 Tax ID Number: 38203XXXX HHS List: 491 XXXX URGENT CARE CENTER 1735 XXXX Ste 450 Okemos,MI 48864 Sanction Code: 1128a1 Sanction Type: Program Related Conviction Sanction Date: 2005/11/20 Entity #3817587 DEA List: AG3117808 MELINDA SMITH 1735 XXXX Unit 450 Okomos,MI 48864 DEA Number: AG3XXXX08 EAS Entity #2923070 DEA List: BG7716333 AMANDA SMITH 1735 XXXX Rd Okemos,MI 48864 DEA Number: BG7XXX333 Gender: M

28. 19 Getting Started:Fraud Data Assessment What we need from you: Meet with Alpine to discuss your needs and objectives Verify availability of data Define the scope of the analysis Execute data security and service agreements Transfer data to Alpine Verify initial results Allocate sufficient resources to investigate leads What you get: Identity Insight Intelligence Report – Contains the results of your analysis (“leads”) .pdf, .xls, .mdb, or other structured format. Service summary – summary of findings; instructions on using the reports and tools; technical recommendations Tutorial on how to use the reports/tools Optional: Investigative support services

29. Summary:Fraud is more than a “cost of doing business” 20

30. 21 Q&A / Contact Information Thanks! Questions? Contact Info: Corporate HQ: West Coast US: Stan Duda Earl Stevens (224) 520-7400 (702) 688-0628 sduda@alpineinc.comestevens@alpineinc.com

31. Alpine Consulting Overview 22

32. Alpine Core Solutions E-Commerce Portals Managed Services Information Management Custom Development User Interface Design, Usability, LAF Design, ADA, SEO, Training Strategic UI Application Security, Assessment and Development Security Accelerate ROI and extend the value of your existing IT solutions IT Strategy, Technology/Application Selection, Interim IT Management CIO Services