Michael Fiorenza, DDS & Tyrette Hamilton, P&R

"Trends In Dental Claims Submission and The Impact on Dental Fraud, Waste and Abuse"

Michael Fiorenza, DDS & Tyrette (Ty) Hamilton, COO, P&R Dental Strategies

CE Credit hours:1.25

Dental Service Organizations (DSOs) are in all the headlines; technology advancements such as CBCT are increasing in use in dental practices. In this presentation, key trends in the overall dental market and trends in dental utilization will be discussed. These trends will be quantified with data from a large multi-payer claims database. Participants will be also be exposed to clinical observations and examples from actual dental consultant reviews. The presentation will provide insight and methods of detecting fraud and abuse through claims data mining along with clinical observations from dental consultant reviews.

Upon completion, attendees will be able to:
• Understand the role and impact of DSOs in today’s dental care delivery
• Gain insight on the trends in use of new technologies and impact on submission of dental insurance claims
• Understand the impact of changing trends in dentistry from a fraud, waste and abuse perspective
• Understand how certain claim review policies and enforcement (or lack thereof) is contributing to the growing trends in potential fraud, waste and abuse
• Learn how analytic tools can be deployed to assess the cost impact of various outlier behaviors and thus prioritize fraud and abuse resources.

MICHAEL FIORENZA, DDS received a BS degree in Biology from Fordham University in New York and graduated from the Georgetown University School of Dentistry. He then completed a general practice residency at Flushing Hospital in Queens, New York before moving on to private practice. He is the current Dental Director of P&R Dental Strategies, LLC and is responsible for the clinical oversight of all P&R products and services including the day to day management of over sixty Dental Consultants across the country. With over 25 years of experience as a private practicing dentist and as the P&R Dental Director since 2002, he brings a unique experience and perspective when dealing with the various stakeholders in the dental industry.

TYRETTE (TY) HAMILTON As Chief Operating Officer of P&R Dental Strategies, Ty is responsible for the            day-to-day oversight of the company’s claims review and informatics activities. Ty has spent over twenty-five years in medical, dental, vision and other specialized insurance program operations, where she has successfully managed a variety of commercial and public dental programs and has implemented multiple data-driven solutions for quality assurance and quality improvement. Ty has held senior leadership positions with several commercial dental insurance companies, served as the Executive Director of the Texas Healthy Kids Corporation, and served as the Deputy Commissioner, Life/Health Group for the Texas Department of Insurance.