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Healthcare Fraud: Auditing and Detection Guide 1st Edition

4.5 out of 5 stars 4 customer reviews
ISBN-13: 978-0470127100
ISBN-10: 0470127104
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Editorial Reviews

From the Inside Flap

Healthcare Fraud

Auditing And Detection Guide

According to private and public estimates, approximately $24 million is lost per hour to healthcare waste, fraud, and abuse. Still, the impact of healthcare fraud cannot be measured in terms of dollars alone. In addition to burdening the nation with enormous financial costs, it also threatens the quality of healthcare and steals the very essence of human life.

A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud: Auditing and Detection Guide provides tips and techniques to help readers spot the "red flags" of fraudulent activity and reveals the steps to take when fraud is suspected.

Clearly structured to identify what is normal at any point in the healthcare continuum on both individual and cumulative scales, this timely guidebook helps auditing professionals in the healthcare industry to sharpen their fraud detection skills to see beyond the eclipse created by healthcare fraud. Healthcare Fraud: Auditing and Detection Guide features:

  • Comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans

  • A look at how data mapping and mining can be used as a key tool to maximize both the effectiveness and efficiency of fraud investigations

  • Insightful discussion from a number of perspectives—clinical, research, internal audit, investigative, data intelligence, and forensic

  • 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

Healthcare Fraud: Auditing and Detection Guide serves as an invaluable tool equipping healthcare professionals, auditors, and investigators to detect every kind of healthcare fraud, from false statements and claims to elaborate collusive schemes.

From the Back Cover

Praise for Healthcare Fraud

"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 fraud—and how to detect and prevent it—is 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

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Product Details

  • Hardcover: 304 pages
  • Publisher: Wiley; 1 edition (December 4, 2007)
  • Language: English
  • ISBN-10: 0470127104
  • ISBN-13: 978-0470127100
  • Product Dimensions: 6.5 x 1.1 x 9.2 inches
  • Shipping Weight: 1.1 pounds
  • Average Customer Review: 4.5 out of 5 stars  See all reviews (4 customer reviews)
  • Amazon Best Sellers Rank: #1,887,201 in Books (See Top 100 in Books)

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Top Customer Reviews

By Reed D. Gelzer on January 23, 2008
Format: Hardcover
Ms. Busch has done a great service to those who care about the theft of billions by patients, providers, and payers. She demonstrates that no stakeholder group is without taint. Most helpful for both novice and expert are the conceptual models for the business systems that form the health care industry and how those systems are surprisingly easy to manipulate for ill-gotten gains. These models present a virtual menu for how to assess and disassemble the corrupt and fraud-riven status quo at the macro level. The real service of the book is to translate those ideas into concrete steps that compliance officers and investigators can use to manage and prevent fraud. It also presents steps that those in health information management can use to "tighten up" the information streams on which health care fraud depends.

Many thanks to you Ms. Busch for this helpful and instructive resource.

RDGelzer
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Format: Hardcover
While the topic of healthcare fraud may seem a little heavy for "light reading", this book manages to break-out the various issues in an easy-to-read format.

For those of us who know a little about the subject, but want to understand the issues more deeply, Rebecca Busch takes us through an interesting journey - understanding what it is and who commits it, who the players are, the accounting issues, tracking, data mining and profilers - all in under 300 pages.

The style and flow of the book does not overwhelm you and you really can pick it up and put it down whenever you want and easily get back into the material at your own pace.

It is a definite "must have" for the "fraud" section of your bookshelf.
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Format: Hardcover Verified Purchase
It's a very nice book for people who want to get the general picture of how the healthcare industry arrangements work. I would not advise it to someone who already has some experience working in this area because you are not very likely to find anything new.
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Format: Hardcover Verified Purchase
The book arrived with proper packaging, early and was the best price. I would recommend this service through amazon directly anytime
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