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Healthcare Fraud

Author: Rebecca S. Busch
Publisher: John Wiley & Sons
ISBN: 1118240251
Size: 76.96 MB
Format: PDF, Mobi
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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.

Healthcare Fraud

Author: Rebecca S. Busch
Publisher: John Wiley & Sons
ISBN: 9780470227084
Size: 30.84 MB
Format: PDF, Mobi
View: 6051
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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.

Healthcare Fraud Investigation Guidebook

Author: Charles E. Piper
Publisher: CRC Press
ISBN: 1498752616
Size: 57.69 MB
Format: PDF, Docs
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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 suspects Tips on investigative case planning, goals, and strategies Sample visual aids for use when briefing others about your investigative findings Guidance on presenting information obtained from healthcare investigations and on how to testify in court Techniques for uncovering previously undetected fraud The 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 of experience as a federal special agent and certified fraud examiner, the Healthcare Fraud Investigation Guidebook aims to revolutionize the way that healthcare fraud investigations are conducted. It provides the understanding you need to not only put a bandage on the problem of healthcare fraud, but to actually start curing the greed that is poisoning the healthcare industry.

Fraud Analytics Using Descriptive Predictive And Social Network Techniques

Author: Bart Baesens
Publisher: John Wiley & Sons
ISBN: 1119133122
Size: 61.76 MB
Format: PDF, Kindle
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Detect fraud earlier to mitigate loss and prevent cascading damage Fraud Analytics Using Descriptive, Predictive, and Social Network Techniques is an authoritative guidebook for setting up a comprehensive fraud detection analytics solution. Early detection is a key factor in mitigating fraud damage, but it involves more specialized techniques than detecting fraud at the more advanced stages. This invaluable guide details both the theory and technical aspects of these techniques, and provides expert insight into streamlining implementation. Coverage includes data gathering, preprocessing, model building, and post–implementation, with comprehensive guidance on various learning techniques and the data types utilized by each. These techniques are effective for fraud detection across industry boundaries, including applications in insurance fraud, credit card fraud, anti–money laundering, healthcare fraud, telecommunications fraud, click fraud, tax evasion, and more, giving you a highly practical framework for fraud prevention. It is estimated that a typical organization loses about 5% of its revenue to fraud every year. More effective fraud detection is possible, and this book describes the various analytical techniques your organization must implement to put a stop to the revenue leak. Examine fraud patterns in historical data Utilize labeled, unlabeled, and networked data Detect fraud before the damage cascades Reduce losses, increase recovery, and tighten security The longer fraud is allowed to go on, the more harm it causes. It expands exponentially, sending ripples of damage throughout the organization, and becomes more and more complex to track, stop, and reverse. Fraud prevention relies on early and effective fraud detection, enabled by the techniques discussed here. Fraud Analytics Using Descriptive, Predictive, and Social Network Techniques helps you stop fraud in its tracks, and eliminate the opportunities for future occurrence.

Computer Aided Fraud Prevention And Detection

Author: David Coderre
Publisher: John Wiley & Sons
ISBN: 9780470451618
Size: 17.16 MB
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Praise for Computer-Aided Fraud Prevention and Detection: A Step-by-Step Guide "A wonderful desktop reference for anyone trying to move from traditional auditing to integrated auditing. The numerous case studies make it easy to understand and provide a how-to for those?seeking to implement automated tools including continuous assurance. Whether you are just starting down the path or well on your way, it is a valuable resource." -Kate M. Head, CPA, CFE, CISA Associate Director, Audit and Compliance University of South Florida "I have been fortunate enough to learn from Dave's work over the last fifteen years, and this publication is no exception. Using his twenty-plus years of experience, Dave walks through every aspect of detecting fraud with a computer from the genesis of the act to the mining of data for its traces and its ultimate detection. A complete text that first explains how one prevents and detects fraud regardless of technology and then shows how by automating such procedures, the examiners' powers become superhuman." -Richard B. Lanza, President, Cash Recovery Partners, LLC "Computer-Aided Fraud Prevention and Detection: A Step-by-Step Guide helps management and auditors answer T. S. Eliot's timeless question, 'Where is the knowledge lost in information?' Data analysis provides a means to mine the knowledge hidden in our information. Dave Coderre has long been a leader in educating auditors and others about Computer Assisted Audit Techniques. The book combines practical approaches with unique data analysis case examples that compel the readers to try the techniques themselves." -Courtenay Thompson Jr. Consultant, Courtenay Thompson & Associates

Fraud Analytics

Author: Delena D. Spann
Publisher: John Wiley & Sons
ISBN: 1118282736
Size: 78.90 MB
Format: PDF, ePub, Docs
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Proven guidance for expertly using analytics in fraud examinations, financial analysis, auditing and fraud prevention Fraud Analytics thoroughly reveals the elements of analysis that are used in today's fraud examinations, fraud investigations, and financial crime investigations. This valuable resource reviews the types of analysis that should be considered prior to beginning an investigation and explains how to optimally use data mining techniques to detect fraud. Packed with examples and sample cases illustrating pertinent concepts in practice, this book also explores the two major data analytics providers: ACL and IDEA. Looks at elements of analysis used in today's fraud examinations Reveals how to use data mining (fraud analytic) techniques to detect fraud Examines ACL and IDEA as indispensable tools for fraud detection Includes an abundance of sample cases and examples Written by Delena D Spann, Board of Regent (Emeritus) for the Association of Certified Fraud Examiners (ACFE), who currently serves as Advisory Board Member of the Association of Certified Fraud Examiners, Board Member of the Education Task Force of the Association of Certified Anti-Money Laundering Specialists ASIS International (Economic Crime Council) and Advisory Board Member of the Robert Morris University (School of Business), Fraud Analytics equips you with authoritative fraud analysis techniques you can put to use right away.

Financial Statement Fraud

Author: Gerard M. Zack
Publisher: John Wiley & Sons
ISBN: 1118421477
Size: 18.56 MB
Format: PDF, ePub, Mobi
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Valuable guidance for staying one step ahead of financial statement fraud Financial statement fraud is one of the most costly types of fraud and can have a direct financial impact on businesses and individuals, as well as harm investor confidence in the markets. While publications exist on financial statement fraud and roles and responsibilities within companies, there is a need for a practical guide on the different schemes that are used and detection guidance for these schemes. Financial Statement Fraud: Strategies for Detection and Investigation fills that need. Describes every major and emerging type of financial statement fraud, using real-life cases to illustrate the schemes Explains the underlying accounting principles, citing both U.S. GAAP and IFRS that are violated when fraud is perpetrated Provides numerous ratios, red flags, and other techniques useful in detecting financial statement fraud schemes Accompanying website provides full-text copies of documents filed in connection with the cases that are cited as examples in the book, allowing the reader to explore details of each case further Straightforward and insightful, Financial Statement Fraud provides comprehensive coverage on the different ways financial statement fraud is perpetrated, including those that capitalize on the most recent accounting standards developments, such as fair value issues.

Fraud 101

Author: Stephen Pedneault
Publisher: John Wiley & Sons
ISBN: 9780470647844
Size: 36.26 MB
Format: PDF, Mobi
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A straightforward guide explaining the nature of financial fraud Fraud continues to be one of the fastest growing and most costly crimes in the United States and around the world. The more an organization can learn about fraud in general and the potential fraud risks that threaten the financial stability of the organization's cash flow, the better that organization will be equipped to design and implement measures to prevent schemes from occurring in the first place. Fraud 101, Third Edition serves as an enlightening tool for you, whether you are a business owner or manager, an accountant, auditor or college student who needs to learn about the nature of fraud. In this invaluable guide, you will discover and better understand the inner workings of numerous financial schemes and internal controls to increase your awareness and possibly prevent fraud from destroying your organization's financial stability. It offers guidance, understanding, and new, real-world case studies on the major types of fraud, including An understanding of why fraud is committed An overview of financial fraud schemes White-collar crime Uncovering employee embezzlements Establishing internal fraud controls The nature of collecting evidence With case studies included throughout the book to gain insight to the real world of fraud, Fraud 101, Third Edition describes the features of fraud and then provides proven methods of prevention, as well as solutions to expose different types of fraud.