Nuts & bolts of health care fraud examinations

Health care fraud examinations can be laborious. Discovery of evidence can be elusive. You need the most reliable sources and resources. Here’s a practical sampling of some of the best places to start from a fraud examiner who’s worked scores of cases.

Excerpted and adapted from Healthcare Fraud Investigation Guidebook, CRC Press, by Charles E. Piper, CFE, pages 85-97. Available at the ACFE Bookstore, Amazon.

Years ago, I conducted a highly complex financial fraud examination of a contractor. I relied on an experienced auditor and accountant to review and analyze cost and expense reports. He was patient and better at the numbers than me. Because of his expertise in accounting, I later asked him to review a list of questions I planned on asking the chief financial officer (CFO) of the suspect company. The auditor said, “We don’t need to ask these questions because we already know the answers to them.”