From the Inside Flap
Healthcare Fraud Auditing and Detection Guide
The world of healthcare fraud is much more than just pocketing money or a corporate asset. Stealing the very essence of human life, healthcare fraud ranges from false claims by perpetrators who perform needless procedures that disable and kill, to rogue Internet pharmacies. Once limited to petty thefts and deliberately incorrect billing, the world of healthcare fraud has become one of high-tech, highly skilled, educated, and professional perpetrators.
Now completely updated, this Second Edition of Healthcare Fraud: Auditing and Detection Guide is the must-have reference for auditors, fraud investigators, and healthcare managers, revealing proven tips and techniques to help you spot the "red flags" of fraudulent activity, as well as the steps you need to take when fraud is suspected. Author Rebecca Buscha pioneer in conducting technology and process-enabled audits of healthcare claims and processingpresents comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans.
Healthcare Fraud, Second Edition features:
Six new chapters detailing a comprehensive audit model encompassing primary, secondary, information, damages, transparency, and rules-based continuum. Detailed analytic pipelines within each continuum extrapolating components of PHI, dollars involved, operations, products, services, and type of consumer. This integration is the secret sauce to any successful investigation.
How data mapping and mining can be used as a key tool to maximize the effectiveness of fraud investigations
Insightful discussion from a number of perspectives; clinical, research, internal audit, investigative, data intelligence, and forensic
A behind-the-scenes look at internal controls and anomaly tracking systems for ongoing monitoring and surveillance
Building blocks for understanding the entire healthcare market and its respective players
Cases and methodologies providing actual audit and investigative tools
Useful outlines of healthcare fraud prevention, detection, and investigation methods
Sharpen your skills as an auditor or investigator to identify incontrovertible truth with the visionary guidance found in Healthcare Fraud, Second Edition.
From the Back Cover
Praise for the previous edition of Healthcare Fraud Auditing and Detection Guide
"Rebecca Busch has taken the cumbersome and complex subject of healthcare fraud and dissected it into well-defined parts. Her thoughtful discussion of how and where these parts provide opportunities for fraudand how to detect and prevent itis the essence of this work. This book is a must-read for anyone involved in the prevention, detection, and investigation of healthcare fraud."
Robert M. Bryant President and Chief Executive Officer, National Insurance Crime Bureau
"Fraud continues to be a major subject area for internal auditors. Recent studies by the IIA show that healthcare audits are in the top ten subject areas audited. This book speaks to the necessary background that internal auditors should have when auditing healthcare activities so that they can have the necessary skills to look for and deal with potential fraudulent situations. I recommend this book be part of every internal audit department's library."
Dave Richards, CIA, CPAPresident, The Institute of Internal Auditors
"The cost of healthcare fraud continues to escalate each year. It is a terrible burden on our already fragile healthcare system. This book will provide anti-fraud professionals with a valuable resource to help combat this critical problem."
James D. Ratley, CFEPresident, Association of Certified Fraud Examiners
"Rebecca Busch's Healthcare Fraud: Auditing and Detection Guide fills a critical gap in anti-fraud literature. Written professionally and precisely, yet eminently readable, this book will be the 'go to' source for managers, academics, attorneys, auditors, and fraud examiners involved in healthcare. Healthcare Fraud: Auditing and Detection Guide demonstrates Ms. Busch's expertise and depth of knowledge in the area of healthcare fraud, and is testimony as to why she is such a sought-after speaker and educator."
William J. Kresse, MS, JD, CPA, CFEAssistant Professor, Saint Xavier UniversityGraham School of Management2007 ACFE Educator of the Year