Fraud Control In The Health Care Industry
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Fraud Control In The Health Care Industry
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Author : Malcolm K. Sparrow
language : en
Publisher:
Release Date : 1998
Fraud Control In The Health Care Industry written by Malcolm K. Sparrow and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1998 with Electronic government information categories.
Healthcare Fraud
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Author : Rebecca S. Busch
language : en
Publisher: John Wiley & Sons
Release Date : 2012-05-01
Healthcare Fraud written by Rebecca S. Busch and has been published by John Wiley & Sons this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012-05-01 with Business & Economics categories.
An invaluable tool equipping healthcare professionals, auditors, and investigators to detect every kind of healthcare fraud According to private and public estimates, billions of dollars are lost per hour to healthcare waste, fraud, and abuse. A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud, Second Edition provides tips and techniques to help you spot—and prevent—the "red flags" of fraudulent activity within your organization. Eminently readable, it is your "go-to" resource, equipping you with the necessary skills to look for and deal with potential fraudulent situations. Includes new chapters on primary healthcare, secondary healthcare, information/data management and privacy, damages/risk management, and transparency Offers comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans Examines the necessary background that internal auditors should have when auditing healthcare activities Managing the risks in healthcare fraud requires an understanding of how the healthcare system works and where the key risk areas are. With health records now all being converted to electronic form, the key risk areas and audit process are changing. Read Healthcare Fraud, Second Edition and get the valuable guidance you need to help combat this critical problem.
License To Steal
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Author : Malcolm K. Sparrow
language : en
Publisher: Routledge
Release Date : 2019-03-13
License To Steal written by Malcolm K. Sparrow and has been published by Routledge this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-03-13 with Health & Fitness categories.
This book brings an unusual opportunity to explore the peculiarities of America's health care industry's approach to fraud control, when compared with the financial services sector, credit card companies, or the Internal Revenue Service—all of which have to defend themselves against fraud.
Statistics And Health Care Fraud
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Author : Tahir Ekin
language : en
Publisher: CRC Press
Release Date : 2019-02-07
Statistics And Health Care Fraud written by Tahir Ekin and has been published by CRC Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-02-07 with Mathematics categories.
Statistics and Health Care Fraud: How to Save Billions helps the public to become more informed citizens through discussions of real world health care examples and fraud assessment applications. The author presents statistical and analytical methods used in health care fraud audits without requiring any mathematical background. The public suffers from health care overpayments either directly as patients or indirectly as taxpayers, and fraud analytics provides ways to handle the large size and complexity of these claims. The book starts with a brief overview of global healthcare systems such as U.S. Medicare. This is followed by a discussion of medical overpayments and assessment initiatives using a variety of real world examples. The book covers subjects as: • Description and visualization of medical claims data • Prediction of fraudulent transactions • Detection of excessive billings • Revealing new fraud patterns • Challenges and opportunities with health care fraud analytics Dr. Tahir Ekin is the Brandon Dee Roberts Associate Professor of Quantitative Methods in McCoy College of Business, Texas State University. His previous work experience includes a working as a statistician on health care fraud detection. His scholarly work on health care fraud has been published in a variety of academic journals including International Statistical Review, The American Statistician, and Applied Stochastic Models in Business and Industry. He is a recipient of the Texas State University 2018 Presidential Distinction Award in Scholar Activities and the ASA/NISS y-Bis 2016 Best Paper Awards. He has developed and taught courses in the areas of business statistics, optimization, data mining and analytics. Dr. Ekin also serves as Vice President of the International Society for Business and Industrial Statistics.
Electronic Health Records
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Author : Rebecca S. Busch
language : en
Publisher: John Wiley & Sons
Release Date : 2008-12-15
Electronic Health Records written by Rebecca S. Busch and has been published by John Wiley & Sons this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008-12-15 with Business & Economics categories.
Electronic Health Records: An Audit and Internal Control Guide describes the infrastructure of electronic health records and the impact that the government's new criteria will have on the private and public marketplace. Understand what to look for in a health care record management system and find tips and helpful guidance for implementation. If you are trying to facilitate an audit of a health record management system, you can apply the example described in the model, which will serve as a timely model and invaluable resource.
Integrity Transparency And Corruption In Healthcare Research On Health Volume I
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Author : Kıymet Tunca Çalıyurt
language : en
Publisher: Springer Nature
Release Date : 2020-02-03
Integrity Transparency And Corruption In Healthcare Research On Health Volume I written by Kıymet Tunca Çalıyurt and has been published by Springer Nature this book supported file pdf, txt, epub, kindle and other format this book has been release on 2020-02-03 with Philosophy categories.
This book grapples with the numerous risks organizations face in order to succeed. These include economic risks, disaster risks, supply-chain risks, regulatory risks, and technology risks, all of which affect organizations in different ways and in varying degrees. Referencing Mahatma Gandhi’s seven unethical behaviors in the business world—wealth without work, pleasure without conscience, knowledge without character, commerce without morality, science without humanity, religion without sacrifice, and politics without principle—the authors analyze the healthcare sector. As competition in the health sector increases, there has also been a rise in unethical behavior. Corruption in the health sector results in severe consequences as it could affect the health of millions. This volume explores fraud schemes and cases, legislation to avoid cheating, lack of law, transparency, ethical issues, corporate governance and transparency in the health and pharmaceutical sector bringing together the perspectives of practitioners, professionals, as well as academic authors.
Crime In The Home Health Care Field
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Author : Brian K. Payne
language : en
Publisher: Charles C Thomas Publisher
Release Date : 2003-01-01
Crime In The Home Health Care Field written by Brian K. Payne and has been published by Charles C Thomas Publisher this book supported file pdf, txt, epub, kindle and other format this book has been release on 2003-01-01 with Political Science categories.
Over the past couple of decades, individuals have come to rely more on home health care visits for their health care needs. While there have been decreases in hospital stays and in the percentage of older persons living in nursing homes the consequence has been the emergence of a new type of occupational crime: home health care abuse. In considering offending in the home health care industry, it is important to focus on crimes by and against home health care professionals. This book is one of the first to fully address abuses occurring in the home health care industry. Its intent is not to suggest that home health care is a dangerous field for workers and consumers; rather, the intent is to shed some light on the types of misconduct found in home health care. Each chapter will include a wealth of examples to illustrate that these incidents actually are real, devastating, and significant. At the end of each chapter the reader will find a series of discussion questions designed to encourage the reader to reflect back on the content of the chapter through the eyes of those involved in the response to home health care fraud. Also included are Web site addresses where readers can learn more about the offenses and other resources to help demonstrate ways to deal with the problem. It is intended for criminal justice officials, health care professionals, academics, and researchers who want to better understand the nature of offending in the home health care industry. It is also intended for use in criminal justice, sociology, and white-collar crime courses exploring crime in the workplace as well as courses examining the home health care field. Chapters include: Home, Home on the Range: Where Health Care is Provided and Crimes are Committed; Home Health Care Professionals as Victims and Witnesses; Crimes by Home Health Professionals: Violence, Theft, and Deception; Responding to Crime in the Home Health Care Field: Strategies, Obstacles, and Issues; and Preventing Home Health Care Misconduct.
Crossing The Global Quality Chasm
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Author : National Academies of Sciences, Engineering, and Medicine
language : en
Publisher: National Academies Press
Release Date : 2019-01-27
Crossing The Global Quality Chasm written by National Academies of Sciences, Engineering, and Medicine and has been published by National Academies Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-01-27 with Medical categories.
In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.
License To Steal
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Author : Malcolm K Sparrow
language : en
Publisher: Hachette UK
Release Date : 2007-12-14
License To Steal written by Malcolm K Sparrow and has been published by Hachette UK this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007-12-14 with Political Science categories.
Who steals? An extraordinary range of folk -- from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, and even major hospital chains. In License to Steal, Malcolm K. Sparrow shows how the industry's defenses, which focus mostly on finding and correcting billing errors, are no match for such well orchestrated attacks. The maxim for thieves simply becomes "bill your lies correctly." Provided they do that, fraud perpetrators with any degree of sophistication can steal millions of dollars with impunity, testing payment systems carefully, and then spreading fraudulent billings widely enough across patient and provider accounts to escape detection. The kinds of highly automated, quality controlled claims processing systems that pervade the industry present fraud perpetrators with their favorite kind of target: rich, fast paying, transparent, utterly predictable check printing systems, with little threat of human intervention, and with the U.S. Treasury on the end of the electronic line. Sparrow picks apart the industry's response to the government's efforts to control this problem. The provider associations (well heeled and politically influential) have vociferously opposed almost every recent enforcement initiative, creating the unfortunate public impression that the entire health care industry is against effective fraud control. A significant segment of the industry, it seems, regards fraud and abuse not as a problem, but as a lucrative enterprise worth defending. Meanwhile, it remains a perfectly commonplace experience for patients or their relatives to examine a medical bill and discover that half of it never happened, or that; likewise, if patients then complain, they discover that no one seems to care, or that no one has the resources to do anything about it. Sparrow's research suggests that the growth of capitated managed care systems does not solve the problem, as many in the industry had assumed, but merely changes its form. The managed care environment produces scams involving underutilization, and the withholding of medical care schemes that are harder to uncover and investigate, and much more dangerous to human health. Having worked extensively with federal and state officials since the appearance of his first book on this subject, Sparrow is in a unique position to evaluate recent law enforcement initiatives. He admits the "war on fraud" is at least now engaged, but it is far from won.
License To Steal
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Author : Malcolm K. Sparrow
language : en
Publisher: Routledge
Release Date : 2019-06-07
License To Steal written by Malcolm K. Sparrow and has been published by Routledge this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-06-07 with categories.
Criminal fraud must be factored into the current debates about health care reform, budget deficits, and proposed Medicare/Medicaid cutbacks. As a polity, how can we make good public policy if we don't know how much of the nation's one trillion dollar health care budget is being lost to fraud? The amounts are staggering, measured in hundreds of billions of dollars, but nobody knows for sure exactly how much is being lost. Malcolm Sparrow, an expert on fraud control, reviews how the health care industry approaches the problem and concludes that fraud is rampant, largely uncontrolled, and mostly invisible to policymakers. The problem will only get worse, he says, unless the industry at all levels changes its priorities, its strategies for uncovering and preventing fraud, and its technological approach. Many believe that electronic claims processing will save billions of dollars and that managed care will eliminate the major categories of fraud. By contrast, Sparrow shows how electronic claims processing could lead to unprecedented fraud losses, and how managed care makes fraud much more dangerous to human health. The final section-prescriptions for progress-is a must for policymakers at every level, and for anyone with an interest in the science of fraud control more broadly, in any context.
