healthcare fraud auditing and detection guide

Download Book Healthcare Fraud Auditing And Detection Guide in PDF format. You can Read Online Healthcare Fraud Auditing And Detection Guide here in PDF, EPUB, Mobi or Docx formats.

Healthcare Fraud

Author : Rebecca S. Busch
ISBN : 9781118240250
Genre : Business & Economics
File Size : 43. 93 MB
Format : PDF, ePub
Download : 593
Read : 550

Download Now


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.

Healthcare Fraud

Author : Rebecca S. Busch
ISBN : 0470227087
Genre : Business & Economics
File Size : 34. 67 MB
Format : PDF, ePub
Download : 925
Read : 219

Download Now


According to private and public estimates, approximately $24 million is lost per hour to healthcare waste, fraud, and abuse. A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud: Auditing and Detection Guide 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.

Healthcare Fraud

Author : Rebecca S. Busch
ISBN : 9781118227220
Genre : Business & Economics
File Size : 47. 39 MB
Format : PDF, ePub
Download : 606
Read : 627

Download Now



Healthcare Fraud Investigation Guidebook

Author : Charles E. Piper
ISBN : 9781498752619
Genre : Law
File Size : 85. 63 MB
Format : PDF, ePub
Download : 514
Read : 222

Download Now


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.

Fraud Analytics

Author : Delena D. Spann
ISBN : 9781118282731
Genre : Business & Economics
File Size : 35. 79 MB
Format : PDF, Mobi
Download : 156
Read : 1000

Download Now


Proven guidance for expertly using analytics in fraud examinations, financial analysis, auditing and fraud prevention Fraud Analytics thoroughly reveals the elements of analysis that are used in today's fraud examinations, fraud investigations, and financial crime investigations. This valuable resource reviews the types of analysis that should be considered prior to beginning an investigation and explains how to optimally use data mining techniques to detect fraud. Packed with examples and sample cases illustrating pertinent concepts in practice, this book also explores the two major data analytics providers: ACL and IDEA. Looks at elements of analysis used in today's fraud examinations Reveals how to use data mining (fraud analytic) techniques to detect fraud Examines ACL and IDEA as indispensable tools for fraud detection Includes an abundance of sample cases and examples Written by Delena D Spann, Board of Regent (Emeritus) for the Association of Certified Fraud Examiners (ACFE), who currently serves as Advisory Board Member of the Association of Certified Fraud Examiners, Board Member of the Education Task Force of the Association of Certified Anti-Money Laundering Specialists ASIS International (Economic Crime Council) and Advisory Board Member of the Robert Morris University (School of Business), Fraud Analytics equips you with authoritative fraud analysis techniques you can put to use right away.

Fraud Analytics Using Descriptive Predictive And Social Network Techniques

Author : Bart Baesens
ISBN : 9781119133124
Genre : Computers
File Size : 32. 15 MB
Format : PDF, Mobi
Download : 205
Read : 731

Download Now


Detect fraud earlier to mitigate loss and prevent cascading damage Fraud Analytics Using Descriptive, Predictive, and Social Network Techniques is an authoritative guidebook for setting up a comprehensive fraud detection analytics solution. Early detection is a key factor in mitigating fraud damage, but it involves more specialized techniques than detecting fraud at the more advanced stages. This invaluable guide details both the theory and technical aspects of these techniques, and provides expert insight into streamlining implementation. Coverage includes data gathering, preprocessing, model building, and post–implementation, with comprehensive guidance on various learning techniques and the data types utilized by each. These techniques are effective for fraud detection across industry boundaries, including applications in insurance fraud, credit card fraud, anti–money laundering, healthcare fraud, telecommunications fraud, click fraud, tax evasion, and more, giving you a highly practical framework for fraud prevention. It is estimated that a typical organization loses about 5% of its revenue to fraud every year. More effective fraud detection is possible, and this book describes the various analytical techniques your organization must implement to put a stop to the revenue leak. Examine fraud patterns in historical data Utilize labeled, unlabeled, and networked data Detect fraud before the damage cascades Reduce losses, increase recovery, and tighten security The longer fraud is allowed to go on, the more harm it causes. It expands exponentially, sending ripples of damage throughout the organization, and becomes more and more complex to track, stop, and reverse. Fraud prevention relies on early and effective fraud detection, enabled by the techniques discussed here. Fraud Analytics Using Descriptive, Predictive, and Social Network Techniques helps you stop fraud in its tracks, and eliminate the opportunities for future occurrence.

Personal Healthcare Portfolio

Author : Rebecca Busch
ISBN : 9780615336893
Genre :
File Size : 25. 67 MB
Format : PDF, ePub, Docs
Download : 488
Read : 450

Download Now



Forensic Analytics

Author : Mark Nigrini
ISBN : 1118087631
Genre : Business & Economics
File Size : 30. 82 MB
Format : PDF, ePub, Docs
Download : 116
Read : 1095

Download Now


Discover how to detect fraud, biases, or errors in your data using Access or Excel With over 300 images, Forensic Analytics reviews and shows how twenty substantive and rigorous tests can be used to detect fraud, errors, estimates, or biases in your data. For each test, the original data is shown with the steps needed to get to the final result. The tests range from high-level data overviews to assess the reasonableness of data, to highly focused tests that give small samples of highly suspicious transactions. These tests are relevant to your organization, whether small or large, for profit, nonprofit, or government-related. Demonstrates how to use Access, Excel, and PowerPoint in a forensic setting Explores use of statistical techniques such as Benford's Law, descriptive statistics, correlation, and time-series analysis to detect fraud and errors Discusses the detection of financial statement fraud using various statistical approaches Explains how to score locations, agents, customers, or employees for fraud risk Shows you how to become the data analytics expert in your organization Forensic Analytics shows how you can use Microsoft Access and Excel as your primary data interrogation tools to find exceptional, irregular, and anomalous records.

Expert Fraud Investigation

Author : Tracy L. Coenen
ISBN : 0470447842
Genre : Business & Economics
File Size : 79. 42 MB
Format : PDF, ePub, Docs
Download : 178
Read : 803

Download Now


A fraud investigation is aimed at examining evidence to determine if a fraud occurred, how it happened, who was involved, and how much money was lost. Investigations occur in cases ranging from embezzlement, to falsification of financial statements, to suspicious insurance claims. Expert Fraud Investigation: A Step-by-Step Guide provides all the tools to conduct a fraud investigation, detailing when and how to investigate. This guide takes the professional from the point of opening an investigation, selecting a team, gathering data, and through the entire investigation process. Business executives, auditors, and security professionals will benefit from this book, and companies will find this a useful tool for fighting fraud within their own organizations.

License To Steal

Author : Malcolm K. Sparrow
ISBN : 9780813368108
Genre : Medical
File Size : 27. 80 MB
Format : PDF, Kindle
Download : 610
Read : 404

Download Now


Explains how fraud, abuse, and theft robs the U.S. health-care system of more than $100 billion each year, discussing current controls and how they fail, the government's attempts to solve the problem, the perpetrators responsible--ranging from organized crime syndicates to hospital systems--and what needs to be done to stop it.

Top Download:

Best Books