LEADER 05752nam 2200805Ia 450 001 9910811059503321 005 20200520144314.0 010 $a9786613620552 010 $a9781119203636 010 $a1119203635 010 $a9781118240250 010 $a1118240251 010 $a9781280590726 010 $a1280590726 010 $a9781118227220 010 $a1118227220 035 $a(CKB)2670000000166990 035 $a(EBL)821853 035 $a(OCoLC)784953227 035 $a(SSID)ssj0000622950 035 $a(PQKBManifestationID)11400738 035 $a(PQKBTitleCode)TC0000622950 035 $a(PQKBWorkID)10643597 035 $a(PQKB)10255464 035 $a(Au-PeEL)EBL821853 035 $a(CaPaEBR)ebr10546525 035 $a(CaONFJC)MIL362055 035 $a(CaSebORM)9781118240250 035 $a(MiAaPQ)EBC821853 035 $a(OCoLC)852501587 035 $a(OCoLC)ocn852501587 035 $a(FR-PaCSA)88944183 035 $a(FRCYB88944183)88944183 035 $a(Perlego)1012494 035 $a(EXLCZ)992670000000166990 100 $a20111123d2012 uy 0 101 0 $aeng 135 $aur|n|---||||| 181 $ctxt 182 $cc 183 $acr 200 10$aHealthcare fraud $eauditing and detection guide /$fRebecca Saltiel Busch 205 $a2nd ed. 210 $aHoboken, N.J. $cJohn Wiley & Sons$dc2012 215 $a1 online resource (362 p.) 300 $aIncludes index. 311 08$a9781118179802 311 08$a1118179803 320 $aIncludes bibliographical references and index. 327 $aHealthcare 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 327 $aThe 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 327 $aCHAPTER 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) 327 $aEconomic 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) 327 $aContinuum 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 327 $aHealth Information Pipelines Overview: Implications for Prevention, Detection, and Investigation 330 $aAn 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 f 517 3 $aHealth care fraud 606 $aMedicare fraud 606 $aMedical care$xLaw and legislation$zUnited States$xCriminal provisions 615 0$aMedicare fraud. 615 0$aMedical care$xLaw and legislation$xCriminal provisions. 676 $a345.73/0263 700 $aBusch$b Rebecca S$01616449 801 0$bMiAaPQ 801 1$bMiAaPQ 801 2$bMiAaPQ 906 $aBOOK 912 $a9910811059503321 996 $aHealthcare fraud$93947142 997 $aUNINA