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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Praise for Healthcare Fraud

"Rebecca Busch has taken the cumbersome and complex subject of healthcare fraud and dissected it into well-defined parts. Her thoughtful discussion of how and where these parts provide opportunities for fraud—and how to detect and prevent it—is the essence of this work. This book is a must read for anyone involved in the prevention, detection, and investigation of healthcare fraud."

Robert M. Bryant President and Chief Executive Officer, National Insurance Crime Bureau

"Fraud continues to be a major subject area for internal auditors. Recent studies by the IIA show that healthcare audits are in the top ten subject areas audited. This book speaks to the necessary background that internal auditors should have when auditing healthcare activities so that they can have the necessary skills to look for and deal with potential fraudulent situations. I recommend this book be part of every internal audit department's library."

Dave Richards, CIA, CPAPresident, The Institute of Internal Auditors

"The cost of healthcare fraud continues to escalate each year. It is a terrible burden on our already fragile healthcare system. This book will provide anti-fraud professionals with a valuable resource to help combat this critical problem."

James D. Ratley, CFEPresident, Association of Certified Fraud Examiners

"Rebecca Busch's Healthcare Fraud: Auditing and Detection Guide fills a critical gap in anti-fraud literature. Written professionally and precisely, yet eminently readable, this book will be the 'go to' source for managers, academics, attorneys, auditors, and fraud examiners involved in healthcare. Healthcare Fraud: Auditing and Detection Guide demonstrates Ms. Busch's expertise and depth of knowledge in the area of healthcare fraud, and is testimony as to why she is such a sought-after speaker and educator."

William J. Kresse, MS, JD, CPA, CFEAssistant Professor, Saint Xavier UniversityGraham School of Management2007 ACFE Educator of the Year

  

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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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