Download or read book Fraud Detection and Deterrence in Medicare and Medicaid written by Anton Ferilli and published by Nova Science Publishers. This book was released on 2013-04-09 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Government Accountability Office (GAO) has designated Medicare and Medicaid as high-risk programs, in part due to their susceptibility to improper payments -- estimated to be about $70 billion in fiscal year 2010. Improper payments have many causes, such as submissions of duplicate claims or fraud, waste, and abuse. As the administrator of these programs, the Centers for Medicare and Medicaid Services (CMS) is responsible for safeguarding them from loss. This book explores fraud detection and deterrence in Medicare and Medicaid, with a focus on fraud detection systems; screening providers and suppliers; and program integrity.
Download or read book Fraud Detection Systems Centers for Medicare and Medicaid Services Needs to Ensure More Widespread Use written by Valerie C. Melvin and published by DIANE Publishing. This book was released on 2012-10-07 with total page 49 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book License To Steal written by Malcolm K. Sparrow and published by Routledge. This book was released on 2019-03-13 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Fraud Detection Systems written by U.s. Government Accountability Office and published by . This book was released on 2017-08-17 with total page 50 pages. Available in PDF, EPUB and Kindle. Book excerpt: "GAO has designated Medicare andMedicaid as high-risk programs, inpart due to their susceptibility toimproper payments-estimated to beabout $70 billion in fiscal year 2010.Improper payments have manycauses, such as submissions ofduplicate claims or fraud, waste, andabuse. As the administrator of theseprograms, the Centers for Medicareand Medicaid Services (CMS) isresponsible for safeguarding themfrom loss. To integrate claimsinformation and improve its ability todetect fraud, waste, and abuse inthese programs, CMS initiated twoinformation technology systemprograms: the Integrated DataRepository (IDR) and One ProgramIntegrity (One PI).GAO was asked to (1) assess theextent to which IDR and One PI havebeen developed and implementedand (2) determine CMS's progresstoward achieving its goals andobjectives for using these systems tohelp detect fraud, waste, and abuse.To do so, GAO reviewed system andprogram management plans andother documents and compared themto key practices. GAO alsointerviewed program officials,analyzed system data, and reviewedreported costs and benefits. GAO is recommending that CMS takesteps to finalize plans and reliableschedules for fully implementing..."
Download or read book Fraud Detection Systems written by United States. Government Accountability Office and published by . This book was released on 2011 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Fraud Detection Systems written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2018-01-11 with total page 50 pages. Available in PDF, EPUB and Kindle. Book excerpt: Fraud Detection Systems: Centers for Medicare and Medicaid Services Needs to Ensure More Widespread Use
Download or read book Fraud detection systems written by Valerie C. Melvin and published by . This book was released on 2011 with total page 12 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Eliminating Waste and Fraud in Medicare and Medicaid written by United States. Congress. Senate. Committee on Homeland Security and Governmental Affairs. Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security and published by . This book was released on 2009 with total page 136 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Keeping Fraudulent Providers Out of Medicare and Medicaid written by United States. Congress. House. Committee on Government Reform and Oversight. Subcommittee on Human Resources and Intergovernmental Relations and published by . This book was released on 1996 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Healthcare Fraud written by Rebecca S. Busch and published by John Wiley & Sons. This book was released on 2012-05-01 with total page 374 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Criminal Prosecution as a Deterrent to Health Care Fraud written by United States. Congress. Senate. Committee on the Judiciary. Subcommittee on Crime and Drugs and published by . This book was released on 2010 with total page 108 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Guidelines Manual written by United States Sentencing Commission and published by . This book was released on 1988 with total page 556 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Fighting Fraud and Waste in Medicare and Medicaid written by United States. Congress. Senate. Committee on Appropriations. Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies and published by . This book was released on 2012 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare and Medicaid Frauds written by United States. Congress. Senate. Special Committee on Aging. Subcommittee on Long-Term Care and published by . This book was released on 1976 with total page 224 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Health Care Fraud and Abuse written by Aspen Health Law Center and published by . This book was released on 1998 with total page 156 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Integrity Transparency and Corruption in Healthcare Research on Health Volume I written by Kıymet Tunca Çalıyurt and published by Springer Nature. This book was released on 2020-02-03 with total page 266 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book License To Steal written by Malcolm K Sparrow and published by Basic Books. This book was released on 2007-12-14 with total page 306 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
