Healthcare fraud auditing and detection guide
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,...
| Autor principal: | |
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| Formato: | Libro electrónico |
| Idioma: | Inglés |
| Publicado: |
Hoboken, N.J. :
John Wiley & Sons
c2012.
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| Edición: | 2nd ed |
| Materias: | |
| Ver en Biblioteca Universitat Ramon Llull: | https://discovery.url.edu/permalink/34CSUC_URL/1im36ta/alma991009628696806719 |
Tabla de Contenidos:
- Healthcare Fraud; Contents; Preface; Acknowledgments; CHAPTER 1 Introduction to Healthcare Fraud; What Is Healthcare Fraud?; Healthcare Fraud in the United States; Healthcare Fraud in International Markets; What Does Healthcare Fraud Look Like?; Who Commits Healthcare Fraud?; What Is Healthcare Fraud Examination?; The Primary Healthcare Continuum: An Overview; Healthcare Fraud Overview: Implications for Prevention, Detection, and Investigation; Notes; CHAPTER 2 Defining Market Players within the Primary Healthcare Continuum; The Patient; The Provider; The Payer; The Employer/Plan Sponsor
- The Vendor and the SupplierThe Government; Organized Crime; Market Players Overview: Implications for Prevention, Detection, and Investigation; CHAPTER 3 Continuum Audit and Investigative Model; Market Understanding; The Primary Healthcare Continuum (P-HCC); The Secondary Healthcare Continuum (S-HCC); The Information Healthcare Continuum (I-HCC); The Consequence Healthcare Continuum (C-HCC); The Transparency Healthcare Continuum (T-HCC); The Rules Based Healthcare Continuum (R-HCC); Audit Continuum Models Overview: Implications for Prevention, Detection, and Investigation; Notes
- CHAPTER 4 Secondary Healthcare ContinuumThe Secondary Healthcare Continuum (S-HCC); Audit Continuum Models Overview: Implications for Prevention, Detection, and Investigation; Notes; CHAPTER 5 Information Healthcare Continuum; Case Study Dr. Traveler-Recap; Continuum Audit Progression-Recap; The Information Healthcare Continuum (I-HCC); Audit Continuum Models Overview: Implications for Prevention, Detection, and Investigation; Notes; CHAPTER 6 Consequence Healthcare Continuum; Case Study Dr. Traveler-Recap; Continuum Audit Progression-Recap; The Consequence Healthcare Continuum (C-HCC)
- Economic Business ImpactServiceability and Service Integrity; Service, Medical, and Financial Errors; Audit Continuum Models Overview: Implications for Prevention, Detection, and Investigation; CHAPTER 7 Transparency Healthcare Continuum; Case Study Dr. Traveler-Recap; Continuum Audit Progression-Recap; The Transparency Healthcare Continuum (T-HCC); Audit Continuum Models Overview: Implications for Prevention, Detection, and Investigation; CHAPTER 8 Rules Based Healthcare Continuum; Case Study Dr. Traveler-Recap; The Rules Based Healthcare Continuum (R-HCC)
- Continuum Audit Progression-SummaryAudit Continuum Models Overview: Implications for Prevention, Detection, and Investigation; Notes; CHAPTER 9 Protected Health Information; Health Insurance Portability and Accountability Act of 1996; Audit Guidelines in Using Protected Health Information; Protected Health Information Overview: Implications for Prevention, Detection, and Investigation; CHAPTER 10 Health Information Pipelines; The Auditor's Checklist; What Are the Channels of Communication in a Health Information Pipeline?; Unauthorized Parties
- Health Information Pipelines Overview: Implications for Prevention, Detection, and Investigation
