In this course you will learn how to combat costly health care fraud. You will examine common fraud schemes against government programs, legal initiatives associated with health care fraud, data analytics techniques to identify suspicious activity and the unique aspects of health care fraud investigations.
- How to relate legal violations to fraudulent activities
- Types of health care fraud
- The effects of the U.S. Patient Protection and Affordable Care Act
- Identify the key players in government health care
- What differentiates health care fraud investigations
ACFE Ordering and Return Policy
You Will Learn How To:
- Identify specific types of health care fraud, including billing, coding, marketing, insurer and beneficiary schemes
- Recognize the third-party payment system and the key players in government health care
- Relate legal violations to fraudulent acts
- Identify the ongoing changes resulting from the U.S. Patient Protection and Affordable Care Act
- Choose appropriate data analysis techniques to analyze health care program schemes
- Determine an effective approach to conduct a health care fraud examination
ADVANCED PREPARATION: NONE
FIELD OF STUDY: SPECIALIZED KNOWLEDGE
LAST UPDATED: MARCH 2019
DELIVERY METHOD: QAS SELF-STUDY
Table of Contents:
- Lesson 1: Structure of the U.S. Public Health Care System
- Lesson 2: Key Programs in Public Health Care
- Lesson 3: Health Care Fraud Defined
- Lesson 4: The Effects of Fraud on Public Health Care
- Lesson 5: False Billing Schemes
- Lesson 6: Coding Schemes
- Lesson 7: Corruption Schemes
- Lesson 8: Fraudulent Advertising and Licensing
- Lesson 9: Beneficiary Fraud Schemes
- Lesson 10: Schemes by Other Third Parties
- Lesson 11: Laws Prohibiting Fraud Against Public Health Care Programs
- Lesson 12: Current and Expected Changes from the Affordable Care Act
- Lesson 13: The Role of Data Analysis in Prevention and Detection
- Lesson 14: The Examination Strategy for Health Care Fraud
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Online Self-Study Troubleshooting Guide:
Problem: When I attempt to access my courses from “My Online Learning,” the course never launches, or I receive an error message saying my pop-up blocker needs to be turned off.
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Problem: I receive the following error when I try to load a different lesson with a course:
Solution: This occurs in Internet Explorer when trying to load a different lesson without closing the current lesson. This error can be avoided two different ways:
Always close the current lesson before going to another one. Always click the Close Window button (usually the red “X” in the upper right corner) of the current lesson before clicking on another lesson.
Use a different browser. This error seems to only occur in Internet Explorer, so using Mozilla Firefox or Google Chrome should resolve the issue (see below for links to download either of these browsers).
Other Troubleshooting Tips: If you encounter other errors, such as courses freezing or crashing, we recommend taking the following action:
Try a different browser. ACFE online self-study courses are designed to run on all modern web browsers, but if you encounter a problem that is not solved using one of the suggestions above, you can try using a different web browser to see if it eliminates the problem. We have most frequently seen where using Mozilla Firefox or Google Chrome has resolved an issue that was seen in Internet Explorer.
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Google Chrome can be downloaded here
Make sure you are running the latest version of Flash. Go to Adobe.com to see what version of Flash you are running, and then compare that to the table on that page to see what the latest version is for your operating system/browser combination. If you are not running the newest version, you should upgrade and see if that resolves the problem.