Healthcare Fraud: Auditing and Detection Guide, Second Edition

Healthcare Fraud, Second 


By Rebecca S. Busch, CFE



A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud: Auditing and Detection Guide, Second Edition provides tips and techniques to help you 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 industry on both individual and cumulative scales, this timely guidebook helps auditing professionals in the healthcare industry to sharpen their fraud detection skills.

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

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.



Product Description:
Copyright 2012
ISBN 978-1-118-17980-2
Hardcover, 340 pages
John Wiley & Sons Publishing

Table of Contents:


Chapter 1: Introduction to Healthcare Fraud

Chapter 2: Defining Market Players within the Primary Healthcare Continuum

Chapter 3: Continuum Audit and Investigative Model

Chapter 4: Continuum Audit and Investigative Model

Chapter 5: Information Healthcare Continuum

Chapter 6: Consequence Healthcare Continuum

Chapter 7: Transparency Healthcare Continuum

Chapter 8: Rules Based Healthcare Continuum

Chapter 9: Protected Health Information

Chapter 10: Health Information Pipelines

Chapter 11: Accounts Receivable Pipelines

Chapter 12: Operational Flow Activity

Chapter 13: Product, Service, and Consumer Market Activity

Chapter 14: Data Management

Chapter 15: Normal Infrastructure

Chapter 16: Normal Infrastructure and Anomaly Tracking Systems

Chapter 17: Components of the Data Mapping Process

Chapter 18: Components of the Data Mining Process

Chapter 19: Components of the Data Mapping and Data Mining Process

Chapter 20: Data Analysis Models

Chapter 21: Clinical Content Data Analysis

Chapter 22: Profilers

Chapter 23: Market Implications

Chapter 24: Conclusions