Health Care Fraud
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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.
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.
Health Care Fraud And Abuse
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Author : Aspen Health Law Center
language : en
Publisher:
Release Date : 1998
Health Care Fraud And Abuse written by Aspen Health Law Center and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1998 with Business & Economics categories.
Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.
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.
Health Care Fraud And Abuse
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Author : Linda A. Baumann
language : en
Publisher: Bureau of National Affairs (BNA)
Release Date : 2013
Health Care Fraud And Abuse written by Linda A. Baumann and has been published by Bureau of National Affairs (BNA) this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013 with Health insurance categories.
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.
Health Care Fraud
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Author : Williamd Edward Ackerman, III
language : en
Publisher: Createspace Independent Publishing Platform
Release Date : 2017-09-24
Health Care Fraud written by Williamd Edward Ackerman, III and has been published by Createspace Independent Publishing Platform this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017-09-24 with Medicaid fraud categories.
The medical profession and health care in general has deteriorated over the past twenty years. It has become plagued with fraudulent behaviors. It is difficult for individuals to know if they are being scammed. Fraud unfortunately exists in all aspects of health care today. In 2011, $2.27 trillion was spent on health care and more than four billion health insurance claims were processed in the United States. It is an undisputed reality that some of these health insurance claims are fraudulent. No institution has undone more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that susceptible and sick Americans place in their healthcare. No doctor wants to be identified as being out of step with medical practice norms. Furthermore, most health care providers do not want a decrease in profit margins as well. This book is about the millions of Americans who have access to what some would call the best medical care in the world but are being swindled. Of course, there are millions of uninsured Americans whose access to care is heartlessly limited. The problems of fraudulent health care described in this book are less likely to transpire to the latter group, simply because they receive less medical care. This book is about the relentless expansion of medicine and our health providers increasing tendency to only make a diagnosis so that further treatments can be done to increase their revenues. Americans have been taught to be concerned about their health. We are all aware that types of hidden jeopardies prowl inside of us. The conventional wisdom is that it's always better to know about these dangers so that something can be done. That's why we are so enthusiastic about amazing medical technologies that can detect abnormalities even when we reason we are well. That's also why we welcome the identification of risk factors, disease awareness campaigns, cancer screening, genetic testing etc. Americans love a diagnosis so that they can receive attention and health care whether or not it helps them. But it's also true that we do receive too much of it in some circumstances. Some people are diagnosed and treated needlessly by swindlers who do unnecessary or dangerous treatments to increase their profit which is one reason why this book was written. Our legislators have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life. The majority of health care frauds are committed by a very small minority of dishonest health care providers. Unfortunately, the stock in trade of fraud-doers is to take advantage of the confidence that has been entrusted to them in order to commit ongoing fraud on a very broad scale. Another reason for this book is to inform individuals that rewards can be made by reporting health care fraud by becoming a whistle blower. Health care consumers need to identify these health care fraudsters and report them to ultimately attempt to salvage what remains of our health care structure. Fighting Medicare fraud is an important part of safeguarding our healthcare for future generations. Health deception costs Americans billions of dollars. We all must do our parts to reverse this trend. If you suspect that something has happened illegally with respect to medical care, then it is your duty to blow the whistle. Doing so makes you part of the solution. This book addresses the types of fraud which plague the healthcare industry and describes the most common fraudulent behavior throughout this industry and how to report fraud and possibly receive a reward. We must all do our part in trying to save our health care system!
Phantom Billing Fake Prescriptions And The High Cost Of Medicine
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Author : Terry L. Leap
language : en
Publisher: Cornell University Press
Release Date : 2011-04-15
Phantom Billing Fake Prescriptions And The High Cost Of Medicine written by Terry L. Leap and has been published by Cornell University Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011-04-15 with Medical categories.
U.S. health care is a $2.5 trillion system that accounts for more than 17 percent of the nation’s GDP. It is also highly susceptible to fraud. Estimates vary, but some observers believe that as much as 10 percent of all medical billing involves some type of fraud. In 2009, New York’s Medicaid fraud office recovered $283 million and obtained 148 criminal convictions. In July 2010, the U.S. Justice Department charged nearly 100 patients, doctors, and health care executives in five states of bilking the Medicare system out of more than $251 million through false claims for services that were medically unnecessary or never provided. These cases only hint at the scope of the problem. In Phantom Billing, Fake Prescriptions, and the High Cost of Medicine, Terry L. Leap takes on medical fraud and its economic, psychological, and social costs. Illustrated throughout with dozens of specific and often fascinating cases, this book covers a wide variety of crimes: kickbacks, illicit referrals, overcharging and double billing, upcoding, unbundling, rent-a-patient and pill-mill schemes, insurance scams, short-pilling, off-label marketing of pharmaceuticals, and rebate fraud, as well as criminal acts that enable this fraud (mail and wire fraud, conspiracy, and money laundering). After assessing the effectiveness of the federal laws designed to fight health care fraud and abuse—the antikickback statute, the Stark Law, the False Claims Act, HIPAA, and the food and drug laws—Leap suggests a number of ways that health care providers, consumers, insurers, and federal and state officials can bring health care fraud and abuse under control, thereby reducing the overall cost of medical care in America.
Trillion Dollar Scam
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Author : Saul William Seidman
language : en
Publisher: Universal-Publishers
Release Date : 2008
Trillion Dollar Scam written by Saul William Seidman and has been published by Universal-Publishers this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008 with Business & Economics categories.
Fraud is the result of government and insurance company control of health care. The growth of bureaucracy is a precursor to incompetence and soaring costs of medical care. A lack of clinical diagnosis and a dependence on expensive testing has increased costs while decreasing the doctor's competence. The FBI and the attorneys general of all states are dealing with exploding health care fraud. The result is a trillion dollars in waste and deception. Trillion Dollar Scam details the origin of this fraud and waste, and offers solutions to fixing the broken U.S. health care system.
Health Care Fraud
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Author : United States. Congress. Senate. Committee on Appropriations. Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies
language : en
Publisher:
Release Date : 1994
Health Care Fraud written by United States. Congress. Senate. Committee on Appropriations. Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1994 with Medical categories.