Healthcare fraud : auditing and detection guide by Rebecca S. Busch

By Rebecca S. Busch

In response to deepest and public estimates, nearly 24 million is misplaced according to hour to healthcare waste, fraud, and abuse. essential reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud: Auditing and Detection consultant offers assistance and strategies that will help you spot-and prevent-the "red flags" of fraudulent task inside your company. Eminently readable, it's your "go-to" Read more...

summary: in line with deepest and public estimates, nearly 24 million is misplaced consistent with hour to healthcare waste, fraud, and abuse. vital reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud: Auditing and Detection consultant offers tips and methods that will help you spot-and prevent-the "red flags" of fraudulent task inside of your company. Eminently readable, it's your "go-to" source, equipping you with the required abilities to seem for and take care of capability fraudulent events

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The payer is literally the one that pays the bill. An interesting quote appeared in a 1919 publication from the Insurance Monitor in response to the idea of health insurance: the opportunities for fraud [in health insurance] upset all statistical calculations . . Health and sickness are vague terms open to endless construction. Death is clearly defined, but to say what shall constitute such loss of health as will justify insurance compensation is no easy task. (July 1919, vol. 67(7), p. 38) Imagine the insight looking back from 2007.

As well as audit trails of protected health information (PHI). In the P-HCC model, money is viewed as equivalent to PHI. 5 that each entity has PHI generated or processed. At each transfer point, money is generated or processed at the same time. 5 shows organized crime as a disconnected illegitimate third party. It is given its own designation as an entity because of the growing number of complex organized crime schemes integrated into the normal flow of business. Healthcare Fraud Overview: Implications for Prevention, Detection, and Investigation Job security for fraud auditors and investigators remains strong: The healthcare industry continues to have large amounts of cash running through it.

In essence, then, there are potentially 257 million people with the perfect psychological profile to commit fraud. APD should be considered when an individual possesses at least three of the following seven characteristics: 1. 2. 3. 4. 5. 6. 7. Failure to conform to social norms Deceitfulness, manipulativeness Impulsivity, failure to plan ahead Irritability, aggressiveness Reckless disregard for the safety of self or others Consistent irresponsibility Lack of remorse after having hurt, mistreated, or stolen from another person P1: OTA/XYZ JWBT664-c01 P2: ABC JWBT664-Busch February 28, 2012 6:49 What Is Healthcare Fraud Examination?

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