Healthcare Fraud: Auditing and Detection Guide, Second Edition



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 Details

ISBN 978-1-118-17980-2
Hardcover, 340 PAGES

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