Healthcare Fraud
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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.
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.
Healthcare Fraud Investigation Guidebook
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Author : Charles E. Piper
language : en
Publisher: CRC Press
Release Date : 2016-03-23
Healthcare Fraud Investigation Guidebook written by Charles E. Piper and has been published by CRC Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2016-03-23 with Law categories.
Some have estimated that healthcare fraud in the United States results in losses of approximately $80 billion a year. Although there are many books available that describe how to "detect" healthcare fraud, few address what must be done after the fraud is detected. Filling this need, Charles Piper’s Healthcare Fraud Investigation Guidebook details not only how to detect healthcare fraud, but also how to "investigate" and prove the wrongdoing to increase the likelihood of successful prosecution in court. The book starts by covering the history of healthcare insurance and the various types of fraud schemes. It presents Charles Piper’s unique approach to investigating (The Piper Method) which allows readers to conduct as many as 10 simultaneous investigations for each case. It emphasizes the importance of simultaneously searching for waste and abuse as well as systemic weaknesses and deficiencies that caused or contributed to the problem or wrongdoing under investigation and then make recommendations for improvement. It also provides: Questions to ask whistleblowers, complainants, employers, employees, and healthcare providers who are suspects Tips on investigative case planning, goals, and strategies Sample visual aids for use when briefing others about your investigative findings Guidance on presenting information obtained from healthcare investigations and on how to testify in court Techniques for uncovering previously undetected fraud The book includes a sample case study that walks readers through a mock case—from the time the case is received through the end. The case study demonstrates how to initiate, plan, and conduct a thorough and complete healthcare fraud investigation while incorporating Piper’s proven methodology. Sharing insights gained through Charles Piper’s decades of experience as a federal special agent and certified fraud examiner, the Healthcare Fraud Investigation Guidebook aims to revolutionize the way that healthcare fraud investigations are conducted. It provides the understanding you need to not only put a bandage on the problem of healthcare fraud, but to actually start curing the greed that is poisoning the healthcare industry.
Prosecuting And Defending Healthcare Fraud Cases
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Author : Michael K. Loucks
language : en
Publisher:
Release Date : 2007-01-01
Prosecuting And Defending Healthcare Fraud Cases written by Michael K. Loucks and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007-01-01 with categories.
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!
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.
Healthcare Crime
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Author : Kelly M. Pyrek
language : en
Publisher: CRC Press
Release Date : 2011-01-19
Healthcare Crime written by Kelly M. Pyrek and has been published by CRC Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011-01-19 with Law categories.
Crime perpetrated by healthcare professionals is increasingly pervasive in today‘s hospitals and other healthcare settings. Patients, coworkers, and employers are vulnerable to exploitation, fraud, abuse, and even murder. Investigative journalist Kelly M. Pyrek interviews experts who provide accounts concerning the range of criminality lurking in t
Healthcare Fraud And Abuse Introduction
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Author : Daniel Farb
language : en
Publisher: University of Health Care
Release Date : 2004
Healthcare Fraud And Abuse Introduction written by Daniel Farb and has been published by University of Health Care this book supported file pdf, txt, epub, kindle and other format this book has been release on 2004 with Medical categories.
Healthcare Fraud and Abuse Introduction should be used for two purposes: informing one's organization about fraud and abuse and for documenting their training as part of a compliance program.
Healthcare Fraud Corruption And Waste In Europe
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Author : Misja Mikkers
language : en
Publisher:
Release Date : 2017
Healthcare Fraud Corruption And Waste In Europe written by Misja Mikkers and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017 with Europe categories.
The lack of well-documented, factual information on fraud, waste and corruption in the healthcare sector is an important ally for those who would seek to abuse healthcare systems for their own profit. Our lack of knowledge of the incidence, nature and extent of fraud, waste and corruption in healthcare is a threat to the establishment of effective counter-fraud strategies. It prevents those who finance healthcare provision from understanding in clear and quantifiable terms the need to invest resources into counter-fraud activities. As a consequence, fraud remains a matter of moral hazard and healthcare systems continue to suffer considerable financial damage, as well as all the associated consequences for the quality of care that patients receive. It was for these reasons that the 'European Healthcare Fraud and Corruption Network' (EHFCN) and the 'Dutch Healthcare Authority' (NZa, member of EHFCN) decided to collaborate to publish this book... --
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.