Healthcare Fraud: Auditing and Detection Guide
Healthcare Fraud Auditing and Detection GuideThe world of healthcare fraud is much more than just pocketing money or a corporate asset. Stealing the very essence of human life, healthcare fraud ranges from false claims by perpetrators who perform needless procedures that disable and kill, to rogue Internet pharmacies. Once limited to petty thefts and deliberately incorrect billing, the world of healthcare fraud has become one of high-tech, highly skilled, educated, and professional perpetrators.Now completely updated, this Second Edition of Healthcare Fraud: Auditing and Detection Guide is the must-have reference for auditors, fraud investigators, and healthcare managers, revealing proven tips and techniques to help you spot the "red flags" of fraudulent activity, as well as the steps you need to take when fraud is suspected. Author Rebecca Busch—a pioneer in conducting technology and process-enabled audits of healthcare claims and processing—presents comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans.Healthcare Fraud, Second Edition features:Six new chapters detailing a comprehensive audit model encompassing primary, secondary, information, damages, transparency, and rules-based continuum. Detailed analytic pipelines within each continuum extrapolating components of PHI, dollars involved, operations, products, services, and type of consumer. This integration is the secret sauce to any successful investigation.How data mapping and mining can be used as a key tool to maximize the effectiveness of fraud investigationsInsightful discussion from a number of perspectives; clinical, research, internal audit, investigative, data intelligence, and forensicA behind-the-scenes look at internal controls and anomaly tracking systems for ongoing monitoring and surveillanceBuilding blocks for understanding the entire healthcare market and its respective playersCases and methodologies providing actual audit and investigative toolsUseful outlines of healthcare fraud prevention, detection, and investigation methodsSharpen your skills as an auditor or investigator to identify incontrovertible truth with the visionary guidance found in Healthcare Fraud, Second Edition.