Healthcare Fraud Investigation Guidebook PDF Download
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Author: Charles E. Piper
Publisher: Taylor & Francis
ISBN: 1040081797
Category : Law
Languages : en
Pages : 172
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Book Description
Some have estimated that healthcare fraud in the United States results in losses of approximately $80 billion a year. Although there are many books available that describe how to detect healthcare fraud, few address what must be done after the fraud is detected. Filling this need, Charles Piper‘s Healthcare Fraud Investigation Guidebook details not only how to detect healthcare fraud, but also how to investigate and prove the wrongdoing to increase the likelihood of successful prosecution in court.The book starts by covering the history of healthcare insurance and the various types of fraud schemes. It presents Charles Piper‘s unique approach to investigating (The Piper Method) which allows readers to conduct as many as 10 simultaneous investigations for each case. It emphasizes the importance of simultaneously searching for waste and abuse as well as systemic weaknesses and deficiencies that caused or contributed to the problem or wrongdoing under investigation and then make recommendations for improvement. It also provides:Questions to ask whistleblowers, complainants, employers, employees, and healthcare providers who are suspectsTips on investigative case planning, goals, and strategiesSample visual aids for use when briefing others about your investigative findingsGuidance on presenting information obtained from healthcare investigations and on how to testify in courtTechniques for uncovering previously undetected fraudThe book includes a sample case study that walks readers through a mock case from the time the case is received through the end. The case study demonstrates how to initiate, plan, and conduct a thorough and complete healthcare fraud investigation while incorporating Piper‘s proven methodology.Sharing insights gained through Charles Piper‘s decades o
Author: Charles E. Piper
Publisher: Taylor & Francis
ISBN: 1040081797
Category : Law
Languages : en
Pages : 172
Get Book Here
Book Description
Some have estimated that healthcare fraud in the United States results in losses of approximately $80 billion a year. Although there are many books available that describe how to detect healthcare fraud, few address what must be done after the fraud is detected. Filling this need, Charles Piper‘s Healthcare Fraud Investigation Guidebook details not only how to detect healthcare fraud, but also how to investigate and prove the wrongdoing to increase the likelihood of successful prosecution in court.The book starts by covering the history of healthcare insurance and the various types of fraud schemes. It presents Charles Piper‘s unique approach to investigating (The Piper Method) which allows readers to conduct as many as 10 simultaneous investigations for each case. It emphasizes the importance of simultaneously searching for waste and abuse as well as systemic weaknesses and deficiencies that caused or contributed to the problem or wrongdoing under investigation and then make recommendations for improvement. It also provides:Questions to ask whistleblowers, complainants, employers, employees, and healthcare providers who are suspectsTips on investigative case planning, goals, and strategiesSample visual aids for use when briefing others about your investigative findingsGuidance on presenting information obtained from healthcare investigations and on how to testify in courtTechniques for uncovering previously undetected fraudThe book includes a sample case study that walks readers through a mock case from the time the case is received through the end. The case study demonstrates how to initiate, plan, and conduct a thorough and complete healthcare fraud investigation while incorporating Piper‘s proven methodology.Sharing insights gained through Charles Piper‘s decades o
Author: Melissa L. Rorie
Publisher: John Wiley & Sons
ISBN: 1118774833
Category : Social Science
Languages : en
Pages : 646
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Book Description
A comprehensive and state-of the-art overview from internationally-recognized experts on white-collar crime covering a broad range of topics from many perspectives Law enforcement professionals and criminal justice scholars have debated the most appropriate definition of “white-collar crime” ever since Edwin Sutherland first coined the phrase in his speech to the American Sociological Society in 1939. The conceptual ambiguity surrounding the term has challenged efforts to construct a body of science that meaningfully informs policy and theory. The Handbook of White-Collar Crime is a unique re-framing of traditional discussions that discusses common topics of white-collar crime—who the offenders are, who the victims are, how these crimes are punished, theoretical explanations—while exploring how the choice of one definition over another affects research and scholarship on the subject. Providing a one-volume overview of research on white-collar crime, this book presents diverse perspectives from an international team of both established and newer scholars that review theory, policy, and empirical work on a broad range of topics. Chapters explore the extent and cost of white-collar crimes, individual- as well as organizational- and macro-level theories of crime, law enforcement roles in prevention and intervention, crimes in Africa and South America, the influence of technology and globalization, and more. This important resource: Explores diverse implications for future theory, policy, and research on current and emerging issues in the field Clarifies distinct characteristics of specific types of offences within the general archetype of white-collar crime Includes chapters written by researchers from countries commonly underrepresented in the field Examines the real-world impact of ambiguous definitions of white-collar crime on prevention, investigation, and punishment Offers critical examination of how definitional decisions steer the direction of criminological scholarship Accessible to readers at the undergraduate level, yet equally relevant for experienced practitioners, academics, and researchers, The Handbook of White-Collar Crime is an innovative, substantial contribution to contemporary scholarship in the field.
Author:
Publisher:
ISBN:
Category : Internet
Languages : en
Pages : 112
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Book Description
Author: Melissa L. Rorie
Publisher: John Wiley & Sons
ISBN: 1118774795
Category : Social Science
Languages : en
Pages : 546
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Book Description
A comprehensive and state-of the-art overview from internationally-recognized experts on white-collar crime covering a broad range of topics from many perspectives Law enforcement professionals and criminal justice scholars have debated the most appropriate definition of “white-collar crime” ever since Edwin Sutherland first coined the phrase in his speech to the American Sociological Society in 1939. The conceptual ambiguity surrounding the term has challenged efforts to construct a body of science that meaningfully informs policy and theory. The Handbook of White-Collar Crime is a unique re-framing of traditional discussions that discusses common topics of white-collar crime—who the offenders are, who the victims are, how these crimes are punished, theoretical explanations—while exploring how the choice of one definition over another affects research and scholarship on the subject. Providing a one-volume overview of research on white-collar crime, this book presents diverse perspectives from an international team of both established and newer scholars that review theory, policy, and empirical work on a broad range of topics. Chapters explore the extent and cost of white-collar crimes, individual- as well as organizational- and macro-level theories of crime, law enforcement roles in prevention and intervention, crimes in Africa and South America, the influence of technology and globalization, and more. This important resource: Explores diverse implications for future theory, policy, and research on current and emerging issues in the field Clarifies distinct characteristics of specific types of offences within the general archetype of white-collar crime Includes chapters written by researchers from countries commonly underrepresented in the field Examines the real-world impact of ambiguous definitions of white-collar crime on prevention, investigation, and punishment Offers critical examination of how definitional decisions steer the direction of criminological scholarship Accessible to readers at the undergraduate level, yet equally relevant for experienced practitioners, academics, and researchers, The Handbook of White-Collar Crime is an innovative, substantial contribution to contemporary scholarship in the field.
Author: Kelly M. Pyrek
Publisher: CRC Press
ISBN: 1040080995
Category : Law
Languages : en
Pages : 185
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Book Description
Crime perpetrated by healthcare professionals is increasingly pervasive in today‘s hospitals and other healthcare settings. Patients, coworkers, and employers are vulnerable to exploitation, fraud, abuse, and even murder. Investigative journalist Kelly M. Pyrek interviews experts who provide accounts concerning the range of criminality lurking in t
Author: Karen L. Pellegrin
Publisher: SAGE Publications
ISBN: 1071910043
Category : Business & Economics
Languages : en
Pages : 163
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Book Description
Healthcare′s advancements are undeniable, but delivering good value remains a challenge. Costs rise while quality improvements lag, leading some to call for removing business from healthcare entirely. This book offers a different perspective, inviting students and professionals to consider the potential of evidence-based business practices to improve healthcare and reduce costs. This engaging guide explores the unique complexities of the healthcare industry, highlighting why it′s ripe for disruption through innovative business solutions. By delving into how traditional models might not fit healthcare perfectly, the book paves the way for understanding how better business practices can unlock the potential for higher quality care at a lower cost.
Author: Rebecca S. Busch
Publisher: John Wiley & Sons
ISBN: 1118179803
Category : Business & Economics
Languages : en
Pages : 374
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Book Description
An invaluable tool equipping healthcare professionals, auditors, and investigators to detect every kind of healthcare fraud According to private and public estimates, billions of dollars are lost per hour to healthcare waste, fraud, and abuse. A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud, Second Edition 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. Includes new chapters on primary healthcare, secondary healthcare, information/data management and privacy, damages/risk management, and transparency Offers comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans Examines the necessary background that internal auditors should have when auditing healthcare activities Managing the risks in healthcare fraud requires an understanding of how the healthcare system works and where the key risk areas are. With health records now all being converted to electronic form, the key risk areas and audit process are changing. Read Healthcare Fraud, Second Edition and get the valuable guidance you need to help combat this critical problem.
Author: Tracy L. Coenen
Publisher: John Wiley & Sons
ISBN: 0470447842
Category : Business & Economics
Languages : en
Pages : 244
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Book Description
A fraud investigation is aimed at examining evidence to determine if a fraud occurred, how it happened, who was involved, and how much money was lost. Investigations occur in cases ranging from embezzlement, to falsification of financial statements, to suspicious insurance claims. Expert Fraud Investigation: A Step-by-Step Guide provides all the tools to conduct a fraud investigation, detailing when and how to investigate. This guide takes the professional from the point of opening an investigation, selecting a team, gathering data, and through the entire investigation process. Business executives, auditors, and security professionals will benefit from this book, and companies will find this a useful tool for fighting fraud within their own organizations.
Author: Malcolm K Sparrow
Publisher: Basic Books
ISBN: 0465010741
Category : Political Science
Languages : en
Pages : 306
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Book Description
Who steals? An extraordinary range of folk -- from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, and even major hospital chains. In License to Steal, Malcolm K. Sparrow shows how the industry's defenses, which focus mostly on finding and correcting billing errors, are no match for such well orchestrated attacks. The maxim for thieves simply becomes "bill your lies correctly." Provided they do that, fraud perpetrators with any degree of sophistication can steal millions of dollars with impunity, testing payment systems carefully, and then spreading fraudulent billings widely enough across patient and provider accounts to escape detection. The kinds of highly automated, quality controlled claims processing systems that pervade the industry present fraud perpetrators with their favorite kind of target: rich, fast paying, transparent, utterly predictable check printing systems, with little threat of human intervention, and with the U.S. Treasury on the end of the electronic line. Sparrow picks apart the industry's response to the government's efforts to control this problem. The provider associations (well heeled and politically influential) have vociferously opposed almost every recent enforcement initiative, creating the unfortunate public impression that the entire health care industry is against effective fraud control. A significant segment of the industry, it seems, regards fraud and abuse not as a problem, but as a lucrative enterprise worth defending. Meanwhile, it remains a perfectly commonplace experience for patients or their relatives to examine a medical bill and discover that half of it never happened, or that; likewise, if patients then complain, they discover that no one seems to care, or that no one has the resources to do anything about it. Sparrow's research suggests that the growth of capitated managed care systems does not solve the problem, as many in the industry had assumed, but merely changes its form. The managed care environment produces scams involving underutilization, and the withholding of medical care schemes that are harder to uncover and investigate, and much more dangerous to human health. Having worked extensively with federal and state officials since the appearance of his first book on this subject, Sparrow is in a unique position to evaluate recent law enforcement initiatives. He admits the "war on fraud" is at least now engaged, but it is far from won.
Author:
Publisher:
ISBN:
Category : Employee fringe benefits
Languages : en
Pages : 796
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Book Description
