Fraud Against Government Health Care Programs

Laptop displaying an image of stimulus checks
Course Level
Delivered via
4 Credits


Health care is one of the largest and arguably the most complex of all industries in the U.S. The system consists of numerous types of organizations, a vast body of regulations, a diversified consumer base, competing special interests and a massive amount of funds changing hands on a daily basis. Many of these traits that make the health care industry unique are the same ones that make it susceptible to fraud. 

In this course, you will learn how to combat the costly health care fraud epidemic. 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. 

Key Takeaways:

  • 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 



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

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

CPE Information

CPE Credit: 4
NASBA Information: Auditing (Governmental)
Advanced Preparation: None
Last Updated: April 2023
Delivery Method: QAS Self-Study


CPE Credit

Please note: To be eligible for CPE credit, you must complete the final exam within one year of purchase date. You may only claim CPE credit for a course once.

ACFE Online Self-Study Courses


  • 24/7 access to courses through your Internet browser
  • Save time and quickly earn CPE credits with instant access, grading and printable certificate
  • The flexibility to start or stop a course and pick-up right where you left off
  • No additional shipping fees

Learn More about accessing your online self-study course

Learn More about online self-study courses and their features

System Requirements:

  • Internet access: High-speed connection recommended
  • Speakers required for video sound

The Association of Certified Fraud Examiners, Inc. is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website:


Ordering and Returns

Satisfaction Guarantee

If you are not 100% satisfied with any ACFE product, you may return it to us, provided it is in excellent condition, for a full refund of the item minus the cost of shipping. Toolkits and bundles may only be returned as a complete set.

Ordering & Returns Policy