ANAHEIM, Calif., Oct. 29, 2018 /PRNewswire/ -- The National Health Care Anti-Fraud Association (NHCAA) today announced that Roger I. Purnell, AHFI, CFE, Director of the Special Investigations Unit (SIU) at BlueCross BlueShield of North Carolina (BCBSNC), has been elected as Chair of the NHCAA Board of Directors. Purnell succeeds David Popik, AHFI, CFE who served as Senior Director of the Special Investigations Unit at Florida Blue during his Chairmanship. Mr. Popik now serves as SIU Director for national health insurer Humana.
Commenting on the election of Purnell, NHCAA Chief Executive Officer Louis Saccoccio said, "Roger has steadfastly served NHCAA for many years, generously sharing his wide-ranging experience with his industry colleagues. His thoughtful, forward-thinking and direct approach has always benefited the Association. These qualities, along with his decades of experience and inquisitive nature, will be valued assets as he leads our Board of Directors in the coming year. We are proud to have him serve as Chair of the 2019 Board of Directors."
Purnell joined BlueCross BlueShield of North Carolina as SIU Director in June 2009. Under his tenure, the unit has been a pioneer in pre-payment interventions driven by sophisticated data analytics. The SIU is at the forefront of addressing the medical necessity aspects of fraud, waste and abuse (FWA) through the creation of a clinical team examining potential aberrant behavior. Additionally, the BCBSNC SIU has established one of the few facilities-focused investigative teams aimed at addressing FWA in this largely neglected area.
Regarding Purnell's accomplishments while at BCBSNC, Vice President of Audit at BCBS of North Carolina, Tracy R. Bennett had this to say: "Roger Purnell has proven to be a visionary, coming to Blue Cross and Blue Shield of North Carolina with a goal to make it a best in class SIU. I believe he has done just that, as illustrated by the maturity of our data analytics program, cohesion in our workflows between the analysts, investigators and nurses, and collaborative efforts with various other departments around the company such as Medical Policy, Legal, and Network Management. Roger's successes are illustrated in the development of our spike report program, terrific ROI figures, professional growth of staff members, and high percentage of claims denied while still in a pre-payment status. Roger has spearheaded our efforts to move from the pay and chase model of yesterday."
Reflecting on Purnell's devotion to his work, Bennett continues, "Roger is dedicated to the 'FWA cause,' working tirelessly to protect the company and its millions of customers. His concerns are not just around the dollars. Roger is passionate about the clinical integrity of the providers in our network. His dedication to his craft and his commitment to the SIU's mission are unmatched."
Purnell has worked for more than 38 years in the health care regulatory and fraud, waste and abuse detection arenas, spanning the days when special investigations units (SIU) were first being developed, to managing today's highly complex health care fraud investigative apparatus. He has been an active participant in the evolution of the anti-fraud landscape, from its initial recognition as a significant threat to the development and deployment of anti-fraud resources to combat the problem.
Purnell's election was announced in conjunction with NHCAA's Annual Training Conference in Anaheim, California. The Annual Training Conference is the premier event recognized as the nation's leading health care anti-fraud forum for approximately 1,200 public- and private-sector health care anti-fraud professionals.
Founded in 1985, the National Health Care Anti-Fraud Association is the leading national organization focused exclusively on the fight against health care fraud. NHCAA's members comprise more than 100 private health insurers and those public-sector law enforcement and regulatory agencies having jurisdiction over health care fraud committed against both private payers and public programs.
SOURCE National Health Care Anti-Fraud Association