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 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 Contract and Procurement Fraud Investigation Guidebook written by Charles E. Piper and published by Taylor & Francis. This book was released on 2017-06-26 with total page 227 pages. Available in PDF, EPUB and Kindle. Book excerpt: Contract and procurement fraud, collusion, and corruption are worldwide problems. Such wrongdoing causes federal, state, and local governments, as well as private-sector corporations and businesses, to lose funds and profits, while the wrongdoers unjustly benefit. Bid riggers conspire to eliminate fair and open competition and unjustly increase prices, allowing some to monopolize industries. Too often, contracting officials and others responsible for placing orders or awarding contracts compromise their integrity and eliminate fair and open competition to favor vendors offering bribes or gifts. This results in unfair playing fields for vendors and causes financial losses for businesses, government agencies, and taxpayers. Charles Piper’s Contract and Procurement Fraud and Corruption Investigation Guidebook educates readers on fraud and corruption schemes that occur before, during, and after contracts are awarded. This book teaches not only how to identify such wrongdoing, but also how to investigate it and prevent reoccurrence. Piper shares the Piper Method of Conducting Thorough and Complete Investigations, his innovative and proven method of investigating contract and procurement fraud, and demonstrates its principles with personal, on-the-job examples (which he calls "War Stories") woven throughout the text. Intended for criminal justice students, as well as investigators, auditors, examiners, business owners, policy-makers, and other professionals potentially affected by fraud, this book is a must-read guide to effective procurement and contract fraud investigations from inception to testimony.

Download or read book Healthcare Fraud written by Rebecca S. Busch and published by . This book was released on 2012 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: "This second edition provides comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans. New chapters have been added covering a comprehensive auditing model developed by the author on all of the key elements that must be addressed: Primary Healthcare, Secondary Healthcare, Information/Data Management and Privacy, Damages/Risk Management, and transparency. In addition to six new chapters, the current edition material will all be updated and brought up to date"--Provided by publisher.

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 Investigator and Fraud Fighter Guidebook written by Charles E. Piper and published by John Wiley & Sons. This book was released on 2014-04-14 with total page 342 pages. Available in PDF, EPUB and Kindle. Book excerpt: Get federal investigative insight and guidance on conducting thorough investigations and case-building The ability to conduct thorough and effective investigations is a skill that has become increasingly in-demand across many industries. At the same time, investigative resources are dwindling as markets recede. Regulation and financial hurdles impede traditional investigation processes. Even seasoned professionals are finding themselves overtasked or lacking the experience to pursue the types of cases that are accumulating. In Investigator and Fraud Fighter Guidebook: Operation War Stories, author Charles E. Piper, CFE provides insight and guidance on how to conduct thorough and complete investigations while juggling a caseload. Piper served over 30 years in law enforcement-including 20 as an award-winning Federal Special Agent-Criminal Investigator. His wide array of experience allows him to lend a high-level perspective to the art and science of professional investigations of criminal, civil, and administrative cases. In the book, Piper provides guidance on conducting thorough and complete investigations (even with fewer resources) and spotting red flags that often indicate big-picture problems. Piper also shows how to: Identify the suspect's other wrongful acts (similar and otherwise) Identify similar wrongful acts committed by others, and predict future occurrences Identify systemic weaknesses, waste, and abuse Identify changes and corrections necessary to prevent future occurrences The book includes Piper's real-life investigative examples to illustrate important concepts. Whether the matter is public, private, or military, the same basic investigative principles apply. Things that may seem totally unrelated may hold the keys that crack the cases. The Investigator and Fraud Fighter Guidebook: Operation War Stories provides the acumen and judgment required to pick up on these clues and successfully conclude investigations.

Download or read book Investigating White collar Crime written by Howard E. Williams and published by Charles C Thomas Publisher. This book was released on 2006 with total page 300 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 11 chapters of this book are intended to assist police investigators in obtaining the evidence required to prove the distinctive criminal elements of embezzlement and fraud. The first chapter defines "white-collar crime" and describes types of white-collar crime under the categories of crimes by individuals, crimes in the furtherance of legitimate business, and criminal activity disguised as legitimate business. The international scope of white-collar crime and the enforcement of white-collar crime are then discussed. The second chapter focuses on the white-collar crime of embezzlement, which occurs when a person fraudulently appropriates to his/her own benefit money or property entrusted to him/her by another without the effective consent of the owner. Fraud is the subject of the third chapter. Fraud occurs when a person obtains the property of another by deception. The deception involves making representations that are knowingly false by the design of the offender, and these representations are made with the intent to defraud a targeted victim. Relying on these false representations, the victim is induced to voluntarily give his/her property to the offender. The fourth chapter, a new chapter in this second edition, addresses identity theft, its incidence and costs, and the laws that it violates. The remaining chapters focus on the practical aspects of investigating embezzlement, fraud, and identity theft. Separate chapters cover accounting theory for investigators; auditing theory for investigators; financial interviewing and interrogation; public information, subpoenas, and search warrants; evidence and documentation; proving illicit transactions; and case preparation and the investigative report. Seven appendixes pertain to the numerical system of the American Bankers Association, the affidavit of financial information, area assignments of Social Security numbers, a guide to sources for financial information, consent to search, customer consent and authorization for access to financial records, and statement of rights.

Download or read book Risk Management Handbook for Health Care Organizations written by American Society for Healthcare Risk Management (ASHRM) and published by John Wiley & Sons. This book was released on 2009-04-27 with total page 672 pages. Available in PDF, EPUB and Kindle. Book excerpt: Risk Management Handbook for Health Care Organizations, Student Edition This comprehensive textbook provides a complete introduction to risk management in health care. Risk Management Handbook, Student Edition, covers general risk management techniques; standards of health care risk management administration; federal, state and local laws; and methods for integrating patient safety and enterprise risk management into a comprehensive risk management program. The Student Edition is applicable to all health care settings including acute care hospital to hospice, and long term care. Written for students and those new to the topic, each chapter highlights key points and learning objectives, lists key terms, and offers questions for discussion. An instructor's supplement with cases and other material is also available. American Society for Healthcare Risk Management (ASHRM) is a personal membership group of the American Hospital Association with more than 5,000 members representing health care, insurance, law, and other related professions. ASHRM promotes effective and innovative risk management strategies and professional leadership through education, recognition, advocacy, publications, networking, and interactions with leading health care organizations and government agencies. ASHRM initiatives focus on developing and implementing safe and effective patient care practices, preserving financial resources, and maintaining safe working environments.

Download or read book Fraud and Abuse Investigations Handbook for the Healthcare Industry written by Robert A. Griffith and published by . This book was released on 2000 with total page 424 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Exposing Fraud written by Ian Ross and published by John Wiley & Sons. This book was released on 2015-12-02 with total page 280 pages. Available in PDF, EPUB and Kindle. Book excerpt: Foreword by James D. Ratley, CFE, President and CEO, Association of Certified Fraud Examiners Beyond the basics—tools for applied fraud management In Exposing Fraud: Skills, Process, and Practicalities, anti-fraud expert Ian Ross provides both ideas and practical guidelines for applying sound techniques for fraud investigation and detection and related project management. The investigative principles in this book are truly universal and can be applied anywhere in the world to deal with any of the range of fraud types prevalent in today's business environments. Topics covered include cyber fraud, the psychology of fraud, data analysis techniques, and the role of corporate and international culture in criminal behavior, among many others. Ensure an optimal outcome to fraud investigations by mastering real-world skills, from interviewing and handling evidence to conducting criminal proceedings. As technologies and fraud techniques become more complex, fraud investigation must increase in complexity as well. However, this does not mean that time-tested strategies for detecting criminals have become obsolete. Instead, it means that a hands-on approach to fraud detection and management is needed more than ever. The book does just that: Takes a unique practical approach to the business of detecting, understanding, and dealing with fraud of all types Aids in the development of key skills, including conducting investigations and managing fraud risk Covers issues related to ethically and efficiently handling impulsive and systemic fraud, plus investigating criminals who may be running multiple scams Addresses fraud from a global perspective, considering cultural and psychological factors that influence fraudsters Unlike other fraud investigation books on the market, Exposing Fraud develops the ethical and legal foundation required to apply theory and advice in real-world settings. From the simple to the complex, this book demonstrates the most effective application of anti-fraud techniques.

Download or read book Fraud and Abuse Investigations Handbook for the Health Care Industry written by Paul W. Shaw and published by . This book was released on 2021 with total page 775 pages. Available in PDF, EPUB and Kindle. Book excerpt: The authors examine each stage of a fraud and abuse investigation, beginning with an overview of federal and state enforcement agencies, and concluding with a discussion of the potential collateral consequences of an investigation. They have supplemented their analysis extensively with sample documents, including indictments, requests for records, subpoenas, internal response memoranda, and responses to auditors, prosecutors, and more. Taken together, the materials in this book provide a true Handbook for anyone who needs to quickly and thoroughly understand the complex nature of a government fraud and abuse investigation.-Preface.

Download or read book A Guide to Forensic Accounting Investigation written by Steven L. Skalak and published by John Wiley & Sons. This book was released on 2015-12-28 with total page 648 pages. Available in PDF, EPUB and Kindle. Book excerpt: Recent catastrophic business failures have caused some to rethinkthe value of the audit, with many demanding that auditors take moreresponsibility for fraud detection. This book provides forensicaccounting specialists?experts in uncovering fraud?with newcoverage on the latest PCAOB Auditing Standards, the ForeignCorrupt Practices Act, options fraud, as well as fraud in China andits implications. Auditors are equipped with the necessarypractical aids, case examples, and skills for identifyingsituations that call for extended fraud detection procedures.

Download or read book AHLA Fraud and Abuse Investigations Handbook for the Healthcare Industry AHLA Members written by and published by . This book was released on 2016 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Understanding the powers, procedures and remedies available to the government during a health care fraud and abuse investigation, and acquiring a basic understanding of the issues and practical steps to employ during an audit or investigation, are keys to surviving the investigation and achieving a favorable outcome.This new Handbook will arm health care administrators, executives, medical directors, office managers, physicians, and medical practice managers with a broad understanding of this industry-specific area of government enforcement. The resource is complete with:Clear and concise explanations of the lawSample government documents, affidavits, and subpoenas accompanying each chapterIllustrative pleadings and memoranda prepared by prosecutors and defense attorneysThe authors detail the nuts and bolts of a fraud and abuse investigation, from an overview of the various federal and state enforcement agencies to the potential of settling a case. Learn what to expect and how to respond with coverage of:Requests to examine books and records dealing with an organization's programs and operationsInterviews of employees by the OIG or the FBIThe power of HIPAA administrative subpoenas and the broad authority granted under this statuteSteps that should be taken in responding to the government's requestDealing with on-site demands for records and accessInternal audits and investigationsVoluntary disclosuresAffirmative actions to try and fend off an investigation, plea agreements, and deferred prosecution

Download or read book Healthcare Fraud Investigation Guidebook written by Charles E. Piper and published by Taylor & Francis. This book was released on 2017-07-27 with total page 172 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 suspectsTips on investigative case planning, goals, and strategiesSample visual aids for use when briefing others about your investigative findingsGuidance on presenting information obtained from healthcare investigations and on how to testify in courtTechniques for uncovering previously undetected fraudThe 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 o

Download or read book The Foreign Corrupt Practices Act Handbook written by Robert W. Tarun and published by American Bar Association. This book was released on 2010 with total page 564 pages. Available in PDF, EPUB and Kindle. Book excerpt: Identifies all of the major FCPA risk areas and then offers very thoughtful and practical suggestions for how companies can most effectively address these risks and conduct credible investigations. You'll find information on anti-bribery conventions; board of directors and management responsibilities; transaction issues and considerations; gifts, travel, lodging and entertainment; charitable donations and political contributions; and conducting and defending an FCPA Investigation.

Download or read book Guidelines Manual written by United States Sentencing Commission and published by . This book was released on 1988-10 with total page 68 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Fraud and Abuse Investigations Handbook for the Health Care Industry written by Paul W. Shaw and published by . This book was released on 2021 with total page 848 pages. Available in PDF, EPUB and Kindle. Book excerpt: The authors examine each stage of a fraud and abuse investigation, beginning with an overview of federal and state enforcement agencies, and concluding with a discussion of the potential collateral consequences of an investigation. They have supplemented their analysis extensively with sample documents, including indictments, requests for records, subpoenas, internal response memoranda, and responses to auditors, prosecutors, and more. Taken together, the materials in this book provide a true Handbook for anyone who needs to quickly and thoroughly understand the complex nature of a government fraud and abuse investigation.-Preface.