Healthcare fraud [[electronic resource] ] : auditing and detection guide / / Rebecca Saltiel Busch

• Autore: Busch Rebecca S
• Pubblicazione: Hoboken, N.J., : John Wiley & Sons, c2012
• Edizione: 2nd ed.
• Descrizione fisica: 1 online resource (362 p.)
• Disciplina: 345.73/0263
• Soggetto topico: Medicare fraud; Medical care - Law and legislation - United States - Criminal provisions
• Note generali: Includes index.
• Nota di bibliografia: Includes bibliographical references and index.
• Nota di contenuto: 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
• Sommario/riassunto: 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 f
• Titolo autorizzato: Healthcare fraud
• ISBN: 1-119-20363-5; 1-118-24025-1; 1-280-59072-6; 9786613620552; 1-118-22722-0
• Formato: Materiale a stampa
• Livello bibliografico: Monografia
• Lingua di pubblicazione: Inglese
• Record Nr.: 9910141296103321
• Lo trovi qui: Univ. Federico II