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 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 Statistics and Health Care Fraud written by Tahir Ekin and published by CRC Press. This book was released on 2019-02-07 with total page 142 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Healthcare Fraud Investigation Guidebook written by Charles E. Piper and published by CRC Press. This book was released on 2016-03-23 with total page 205 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book License To Steal written by Malcolm K Sparrow and published by Hachette UK. This book was released on 2007-12-14 with total page 304 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.
Download or read book Healthcare Crime written by Kelly M. Pyrek and published by CRC Press. This book was released on 2011-01-19 with total page 326 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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
Download or read book Phantom Billing Fake Prescriptions and the High Cost of Medicine written by Terry L. Leap and published by Cornell University Press. This book was released on 2011-04-15 with total page 253 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Health Care Fraud and Abuse written by Linda A. Baumann and published by Bureau of National Affairs (BNA). This book was released on 2013 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Healthcare Fraud Corruption and Waste in Europe written by Misja Mikkers and published by . This book was released on 2017 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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... --
Download or read book Undercover written by John W. Schilling and published by Author House. This book was released on 2010-09-24 with total page 306 pages. Available in PDF, EPUB and Kindle. Book excerpt: When John Schilling, an unassuming midlevel accountant, joined Columbia Healthcare Corporation -- the nation's fastest growing and revolutionary network of public hospitals -- it seemed like the start of an exciting new career with great advancement and earnings potential. He never expected to become a catalyst for the series of "whistleblower" lawsuits that ripped through the healthcare industry in the late 1990s In Undercover, John Schilling tells the story of his harrowing journey from ordinary citizen and loyal employee to covert FBI informant and top witness for the Justice Department in the largest criminal healthcare fraud case in U.S. history. It began when he stumbled upon evidence-- a $3.5 million accounting "error"--of his company's routine practice of defrauding Medicare. When pressured to comply with stealing from taxpayers, Schilling knew he had to speak up for what he believed was right, regardless of the cost to his job, his reputation, and his family. His courageous choice would consume the next seven years of his life, leading to more drama, angst, turmoil, and money than he could have imagined. Ultimately, Schilling's moral conviction and a little known law, the False Claims Act, paid off by forcing the formidable healthcare conglomerate of Columbia/HCA to pay back $1.7 billion to the federal government. Revealing the personal side of a thankless role, Undercover is a gripping and inspiring account of a long, hard, life-- changing quest for justice. ADVANCE PRAISE FOR UNDERCOVER "Undercover crackles with authenticity as it recounts in a lively, readable style how a man on the inside risked everything and blew the whistle on a giant healthcare company that was systematically looting the Medicare program out of billions. A good read for anyone, but a must-read for someone who may contemplate taking the same path as John Schilling" -- John R. Phillips, "The nation's premier whistleblowing attorney" according to the The Wall Street Journal and the National Law Journal "John Schilling's book is a must-read for whistleblowers. He shows you how hard it can be, yet also shows you how to prevail. Best of all, John shows you how to be a good citizen" -- Jim Moorman, past President, Taxpayers Against Fraud
Download or read book Trillion Dollar Scam written by Saul William Seidman and published by Universal-Publishers. This book was released on 2008 with total page 200 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Health Care Fraud and Abuse written by Hoyt W. Torras and published by American Medical Association Press. This book was released on 2003 with total page 452 pages. Available in PDF, EPUB and Kindle. Book excerpt: A guide for physicians covering the legal aspects of health insurance and offers ways to design an effective billing, coding, and accounts receivable process.
Download or read book Health Care Fraud written by Williamd Edward Ackerman, III and published by Createspace Independent Publishing Platform. This book was released on 2017-09-24 with total page 360 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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!
Download or read book Crossing the Global Quality Chasm written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2019-01-27 with total page 399 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.
Download or read book Profiteering Corruption and Fraud in U S Health Care written by and published by . This book was released on 2020-06 with total page 206 pages. Available in PDF, EPUB and Kindle. Book excerpt: Profiteering, corruption and fraud are emblematic of our profit-driven, corporatized marketplace and so-called health care system. The three bleed into each other in an entangled way, and they are even increasing. We have to ask and answer: who is the health care system for- profits for health care corporations, their shareholders, and Wall Street traders and investors? for the corrupt and fraudulent scammers? or for patients, their families, and taxpayers? The urgent need for health care reform is at an all-time high as the U. S. struggles to deal with the COVID-19 pandemic and the recession certain to follow. We are far behind other advanced nations with one or another system of universal coverage. Incremental attempts to reform U. S. health care have failed for many years. Our broken system is no longer affordable for patients, families, and taxpayers. This book updates where we are with the untenable status quo and compares three major alternatives for reform-building on the ACA, the public option, and Medicare for All.
Download or read book Legal Issues in Health Care Fraud and Abuse written by David E. Matyas and published by . This book was released on 2006 with total page 495 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 2008-03-03 with total page 306 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
