Healthcare Fraud: Auditing and Detection Guide 1st Edition

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.

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