Healthcare Fraud: Auditing and Detection Guide (Google eBook)

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John Wiley & Sons, Mar 3, 2008 - Business & Economics - 320 pages
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According to private and public estimates, approximately $24 million is lost per hour to healthcare waste, fraud, and abuse. A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud: Auditing and Detection Guide provides tips and techniques to help you spot—and prevent—the "red flags" of fraudulent activity within your organization. Eminently readable, it is your “go-to” resource, equipping you with the necessary skills to look for and deal with potential fraudulent situations.
  

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Contents

Auditing and Detection Guide Chapter 1 Introduction to Healthcare Fraud
1
Auditing and Detection Guide Chapter 2 Defining Market Players within the Healthcare Continuum
17
Auditing and Detection Guide Chapter 3 Protected Health Information
51
Auditing and Detection Guide Chapter 4 Health Information Pipelines
57
Auditing and Detection Guide Chapter 5 Accounts Receivable Pipelines
71
Auditing and Detection Guide Chapter 6 Operational Flow Activity
101
Auditing and Detection Guide Chapter 7 Product Service and Consumer Market Activity
109
Auditing and Detection Guide Chapter 8 Data Management
123
Auditing and Detection Guide Chapter 11 Components of the Data Mapping Process
153
Auditing and Detection Guide Chapter 12 Components of the Data Mining Process
159
Auditing and Detection Guide Chapter 13 Components of the Data Mapping and Data Mining Process
165
Auditing and Detection Guide Chapter 14 Data Analysis Models
173
Auditing and Detection Guide Chapter 15 Clinical Content Data Analysis
207
Auditing and Detection Guide Chapter 16 Profilers
239
Auditing and Detection Guide Chapter 17 Market Implications
261
Auditing and Detection Guide Chapter 18 Conclusions
271

Auditing and Detection Guide Chapter 9 Normal Infrastructure
131
Auditing and Detection Guide Chapter 10 Normal Infrastructure and Anomaly Tracking Systems
137

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About the author (2008)

Rebecca S. Busch, RN, MBA, CCM, CBM, CHS-III, CFE, FHFMA, is President and CEO of Medical Business Associates, Inc., a consulting firm specializing in healthcare audits for employers, hospitals, and insurance companies. She has over twenty years of achievement in the healthcare management industry. She is a faculty member of the Association of Certified Fraud Examiners (ACFE), has published numerous articles, and is a frequent public speaker.

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