Healthcare Fraud: Auditing and Detection Guide, Second Edition

By Rebecca S. Busch, CFE

This book’s author is a CFE

Book cover for Healthcare Fraud
Healthcare Fraud Auditing and Detection Guide


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

This book's author is a CFE.
Label Value
ISBN 978-1-118-17980-2
Publisher John Wiley & Sons
Published Copyright 2012
Pages 340
Format Hardcover

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 Secondary Healthcare Continuum
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

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