Health Care Executives' Guide to Fraud and Abuse

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Author :
Publisher : Atlantic Information Systems Incorporated
ISBN 13 : 9780929156378
Total Pages : 134 pages
Book Rating : 4.1/5 (563 download)

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Book Synopsis Health Care Executives' Guide to Fraud and Abuse by : Paul Robert DeMuro

Download or read book Health Care Executives' Guide to Fraud and Abuse written by Paul Robert DeMuro and published by Atlantic Information Systems Incorporated. This book was released on 1998-01-01 with total page 134 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Columbia/HCA "event" was a wake-up call for the health care industry: maintain your status as a partner in good standing" with federal and state governments...or else! The message is clear: the government is serious about not only ferreting out fraud and abuse, but also punishing business crimes with severe, often devastating criminal penalties. Search warrants, grand jury subpoenas, unexpected visits from the IG at your employees' homes, treble damages and stiff penalties are becoming the norm. And ignorance of the laws or the existence of fraud and abuse in a hospital, managed care plan, lab, home health agency or other provider organization is no longer an excuse. This important new book, by two of the nation's top fraud and abuse experts, is written exclusively for health care executives rather than lawyers. It provides a thorough understanding of fraud and abuse across the health care industry by explaining the laws themselves as well as of what those laws mean for executives, physicians, service providers and others working in the industry. Included are straightforward discussions of kickbacks, self-referral bans, reimbursement fraud, what to do when fraud is suspected or uncovered, how to prevent it from occurring, a provider's obligation to report violations, and how to weather fraud and abuse problems if and when they occur.

Healthcare Fraud

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Publisher : John Wiley & Sons
ISBN 13 : 1118179803
Total Pages : 374 pages
Book Rating : 4.1/5 (181 download)

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Book Synopsis Healthcare Fraud by : Rebecca S. Busch

Download or read book Healthcare Fraud written by Rebecca S. Busch and published by John Wiley & Sons. This book was released on 2012-05-01 with total page 374 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.

Fraud and Abuse Investigations Handbook for the Health Care Industry

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Author :
Publisher :
ISBN 13 : 9781663315007
Total Pages : 775 pages
Book Rating : 4.3/5 (15 download)

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Book Synopsis Fraud and Abuse Investigations Handbook for the Health Care Industry by : Paul W. Shaw

Download or read book Fraud and Abuse Investigations Handbook for the Health Care Industry written by Paul W. Shaw and published by . This book was released on 2021 with total page 775 pages. Available in PDF, EPUB and Kindle. Book excerpt: The authors examine each stage of a fraud and abuse investigation, beginning with an overview of federal and state enforcement agencies, and concluding with a discussion of the potential collateral consequences of an investigation. They have supplemented their analysis extensively with sample documents, including indictments, requests for records, subpoenas, internal response memoranda, and responses to auditors, prosecutors, and more. Taken together, the materials in this book provide a true Handbook for anyone who needs to quickly and thoroughly understand the complex nature of a government fraud and abuse investigation.-Preface.

Health Care Fraud and Abuse

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Author :
Publisher : American Medical Association Press
ISBN 13 :
Total Pages : 452 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Health Care Fraud and Abuse by : Hoyt W. Torras

Download or read book Health Care Fraud and Abuse written by Hoyt W. Torras and published by American Medical Association Press. This book was released on 2003 with total page 452 pages. Available in PDF, EPUB and Kindle. Book excerpt: A guide for physicians covering the legal aspects of health insurance and offers ways to design an effective billing, coding, and accounts receivable process.

AHLA Fraud and Abuse Investigations Handbook for the Healthcare Industry (AHLA Members)

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Author :
Publisher :
ISBN 13 : 9780769865652
Total Pages : pages
Book Rating : 4.8/5 (656 download)

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Book Synopsis AHLA Fraud and Abuse Investigations Handbook for the Healthcare Industry (AHLA Members) by :

Download or read book AHLA Fraud and Abuse Investigations Handbook for the Healthcare Industry (AHLA Members) written by and published by . This book was released on 2016 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Understanding the powers, procedures and remedies available to the government during a health care fraud and abuse investigation, and acquiring a basic understanding of the issues and practical steps to employ during an audit or investigation, are keys to surviving the investigation and achieving a favorable outcome.This new Handbook will arm health care administrators, executives, medical directors, office managers, physicians, and medical practice managers with a broad understanding of this industry-specific area of government enforcement. The resource is complete with:Clear and concise explanations of the lawSample government documents, affidavits, and subpoenas accompanying each chapterIllustrative pleadings and memoranda prepared by prosecutors and defense attorneysThe authors detail the nuts and bolts of a fraud and abuse investigation, from an overview of the various federal and state enforcement agencies to the potential of settling a case. Learn what to expect and how to respond with coverage of:Requests to examine books and records dealing with an organization's programs and operationsInterviews of employees by the OIG or the FBIThe power of HIPAA administrative subpoenas and the broad authority granted under this statuteSteps that should be taken in responding to the government's requestDealing with on-site demands for records and accessInternal audits and investigationsVoluntary disclosuresAffirmative actions to try and fend off an investigation, plea agreements, and deferred prosecution

Executive Roadmap to Fraud Prevention and Internal Control

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Author :
Publisher : John Wiley & Sons
ISBN 13 : 0471779679
Total Pages : 417 pages
Book Rating : 4.4/5 (717 download)

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Book Synopsis Executive Roadmap to Fraud Prevention and Internal Control by : Martin T. Biegelman

Download or read book Executive Roadmap to Fraud Prevention and Internal Control written by Martin T. Biegelman and published by John Wiley & Sons. This book was released on 2012-03-14 with total page 417 pages. Available in PDF, EPUB and Kindle. Book excerpt: Praise for Executive Roadmap to Fraud Prevention and InternalControl "Our nation is faced with dual alarming trends of record highs inwhite-collar crime and seemingly record lows in ethics. Thesolution cannot be left only to legislators, regulators, and lawenforcement. It requires the attention of all of us in business tocreate a culture of compliance. This new book by Martin Biegelmanand Joel Bartow is an invaluable resource to achieving the highestlevels of compliance." --Kenneth J. Hunter, former chief postal inspector andformer president & CEO of the Council of Better BusinessBureaus "This is a timely and thought-provoking addition to fraud and riskmanagement literature. For seasoned executives who are navigatingthe maze of compliance, legislative requirements, and increasinglysophisticated criminal activity, this book will be a frequentreference and guide. Neophyte managers will gain years of insightand direction that can only benefit their organizations. Academics,both faculty and students, will learn from the authors' ability toapply theory to high-level practice." --Gary R. Gordon, EdD, Professor of Economic CrimeManagement and Executive Director, Economic Crime Institute ofUtica College "All executives need to protect themselves and their organizationsfrom the potentially catastrophic damage fraud can cause, bothfinancially and reputationally. This new book is a very clear andpractical guide to achieving that goal." --Toby J. F. Bishop, President and Chief Executive Officer,Association of Certified Fraud Examiners "This book is a must-read for anyone eager to understand--andprevent--the toxic mix of temptations that can destroy a company'sreputation overnight. The authors, both seasoned former fraudinvestigators, bring a unique, clear-eyed perspective to the topicof corporate fraud. They have seen it all, and their book is aninvaluable reference for senior management, compliance executives,in-house lawyers, and anyone else who cares about corporateintegrity." --Leslie R. Caldwell, Partner, Morgan Lewis & Bockiusformer director, U.S. Department of Justice Enron Task Force "Excellent resource! A great guide for corporate management in thepost-Enron world." --Karen A. Popp, Partner, Sidley Austin Brown & Wood LLPand former associate counsel to President Bill Clinton and formerfederal prosecutor

Fraud and Abuse Investigations Handbook for the Healthcare Industry

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Author :
Publisher :
ISBN 13 : 9780918945433
Total Pages : 424 pages
Book Rating : 4.9/5 (454 download)

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Book Synopsis Fraud and Abuse Investigations Handbook for the Healthcare Industry by : Robert A. Griffith

Download or read book Fraud and Abuse Investigations Handbook for the Healthcare Industry written by Robert A. Griffith and published by . This book was released on 2000 with total page 424 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Health Care Fraud and Abuse

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Publisher :
ISBN 13 : 9780876328064
Total Pages : 0 pages
Book Rating : 4.3/5 (28 download)

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Book Synopsis Health Care Fraud and Abuse by : Paul P. Cacioppo

Download or read book Health Care Fraud and Abuse written by Paul P. Cacioppo and published by . This book was released on 1991 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Enterprise Fraud and Misuse Management for U.s. Healthcare Payers

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Author :
Publisher : Createspace Independent Publishing Platform
ISBN 13 : 9781978233539
Total Pages : 128 pages
Book Rating : 4.2/5 (335 download)

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Book Synopsis Enterprise Fraud and Misuse Management for U.s. Healthcare Payers by : Gerard Blokdyk

Download or read book Enterprise Fraud and Misuse Management for U.s. Healthcare Payers written by Gerard Blokdyk and published by Createspace Independent Publishing Platform. This book was released on 2017-10-13 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt: Defining, designing, creating, and implementing a process to solve a business challenge or meet a business objective is the most valuable role... In EVERY company, organization and department. Unless you are talking a one-time, single-use project within a business, there should be a process. Whether that process is managed and implemented by humans, AI, or a combination of the two, it needs to be designed by someone with a complex enough perspective to ask the right questions. Someone capable of asking the right questions and step back and say, 'What are we really trying to accomplish here? And is there a different way to look at it?' For more than twenty years, The Art of Service's Self-Assessments empower people who can do just that - whether their title is marketer, entrepreneur, manager, salesperson, consultant, business process manager, executive assistant, IT Manager, CxO etc... - they are the people who rule the future. They are people who watch the process as it happens, and ask the right questions to make the process work better. This book is for managers, advisors, consultants, specialists, professionals and anyone interested in Enterprise Fraud and Misuse Management for U.S. Healthcare Payers assessment. All the tools you need to an in-depth Enterprise Fraud and Misuse Management for U.S. Healthcare Payers Self-Assessment. Featuring new and updated case-based questions, organized into seven core areas of process design, this Self-Assessment will help you identify areas in which Enterprise Fraud and Misuse Management for U.S. Healthcare Payers improvements can be made. In using the questions you will be better able to: - diagnose Enterprise Fraud and Misuse Management for U.S. Healthcare Payers projects, initiatives, organizations, businesses and processes using accepted diagnostic standards and practices - implement evidence-based best practice strategies aligned with overall goals - integrate recent advances in Enterprise Fraud and Misuse Management for U.S. Healthcare Payers and process design strategies into practice according to best practice guidelines Using a Self-Assessment tool known as the Enterprise Fraud and Misuse Management for U.S. Healthcare Payers Scorecard, you will develop a clear picture of which Enterprise Fraud and Misuse Management for U.S. Healthcare Payers areas need attention. Included with your purchase of the book is the Enterprise Fraud and Misuse Management for U.S. Healthcare Payers Self-Assessment downloadable resource, which contains all questions and Self-Assessment areas of this book in a ready to use Excel dashboard, including the self-assessment, graphic insights, and project planning automation - all with examples to get you started with the assessment right away. Access instructions can be found in the book. You are free to use the Self-Assessment contents in your presentations and materials for customers without asking us - we are here to help.

Health Care Fraud and Abuse

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Author :
Publisher : Bna Books
ISBN 13 : 9781570186622
Total Pages : 913 pages
Book Rating : 4.1/5 (866 download)

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Book Synopsis Health Care Fraud and Abuse by : Linda A. Baumann

Download or read book Health Care Fraud and Abuse written by Linda A. Baumann and published by Bna Books. This book was released on 2007 with total page 913 pages. Available in PDF, EPUB and Kindle. Book excerpt: Baumann (of Arent Fox LLP in Washington, DC) presents a general information reference resource for attorneys working in the field of health law that has been revised so as to be current through May 2007, although some material has been updated past that date in order to cover significant new developments, such as the new Stark III regulations issued in September 2007. Following the introduction, nine chapters address federal physician self-referral restrictions; application of the substantive, qui tam, and voluntary disclosure provisions of the False Claims Act in health care prosecutions; practical considerations for defending health care fraud and abuse cases; legal issues surrounding hospital and physician relationships; risk areas in managed care fraud and abuse for government program participants; corporate compliance programs; potential liabilities for directors and officers of health care organizations; disclosure of qui tam suits and investigations; and control of fraud, waste, and abuse in the Medicare Part D Program.

Executive's Guide to IT Governance

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Publisher : John Wiley & Sons
ISBN 13 : 1118138619
Total Pages : 416 pages
Book Rating : 4.1/5 (181 download)

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Book Synopsis Executive's Guide to IT Governance by : Robert R. Moeller

Download or read book Executive's Guide to IT Governance written by Robert R. Moeller and published by John Wiley & Sons. This book was released on 2013-02-11 with total page 416 pages. Available in PDF, EPUB and Kindle. Book excerpt: Create strong IT governance processes In the current business climate where a tremendous amount of importance is being given to governance, risk, and compliance (GRC), the concept of IT governance is becoming an increasingly strong component. Executive's Guide to IT Governance explains IT governance, why it is important to general, financial, and IT managers, along with tips for creating a strong governance, risk, and compliance IT systems process. Written by Robert Moeller, an authority in auditing and IT governance Practical, no-nonsense framework for identifying, planning, delivering, and supporting IT services to your business Helps you identify current strengths and weaknesses of your enterprise IT governance processes Explores how to introduce effective IT governance principles with other enterprise GRC initiatives Other titles by Robert Moeller: IT Audit, Control, and Security and Brink's Modern Internal Auditing: A Common Body of Knowledge There is strong pressure on corporations to have a good understanding of their IT systems and the controls that need to be in place to avoid such things as fraud and security violations. Executive's Guide to IT Governance gives you the tools you need to improve systems processes through IT service management, COBIT, and ITIL.

Healthcare Fraud and Abuse Introduction

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Author :
Publisher : University of Health Care
ISBN 13 : 9781594910920
Total Pages : 0 pages
Book Rating : 4.9/5 (19 download)

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Book Synopsis Healthcare Fraud and Abuse Introduction by : Daniel Farb

Download or read book Healthcare Fraud and Abuse Introduction written by Daniel Farb and published by University of Health Care. This book was released on 2004 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Healthcare Fraud and Abuse Introduction should be used for two purposes: informing one's organization about fraud and abuse and for documenting their training as part of a compliance program.

Health Care Fraud and Abuse

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Publisher :
ISBN 13 :
Total Pages : 156 pages
Book Rating : 4.0/5 ( download)

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Book Synopsis Health Care Fraud and Abuse by : Aspen Health Law Center

Download or read book Health Care Fraud and Abuse written by Aspen Health Law Center and published by . This book was released on 1998 with total page 156 pages. Available in PDF, EPUB and Kindle. Book excerpt: Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.

Healthcare Fraud, Waste, Abuse, and Safe Harbors

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Author :
Publisher : Irwin Professional Publishing
ISBN 13 : 9781557386014
Total Pages : 289 pages
Book Rating : 4.3/5 (86 download)

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Book Synopsis Healthcare Fraud, Waste, Abuse, and Safe Harbors by : Jonathan P. Tomes

Download or read book Healthcare Fraud, Waste, Abuse, and Safe Harbors written by Jonathan P. Tomes and published by Irwin Professional Publishing. This book was released on 1993-01-01 with total page 289 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Fraud, Waste, Abuse and Safe Harbors

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Author :
Publisher : WCB/McGraw-Hill
ISBN 13 : 9781882198016
Total Pages : 94 pages
Book Rating : 4.1/5 (98 download)

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Book Synopsis Fraud, Waste, Abuse and Safe Harbors by : Jonathan P. Tomes

Download or read book Fraud, Waste, Abuse and Safe Harbors written by Jonathan P. Tomes and published by WCB/McGraw-Hill. This book was released on 1993 with total page 94 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Ahla Fraud and Abuse Investigations Handbook for the Healthcare Industry

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Author :
Publisher :
ISBN 13 : 9780769865720
Total Pages : 774 pages
Book Rating : 4.8/5 (657 download)

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Book Synopsis Ahla Fraud and Abuse Investigations Handbook for the Healthcare Industry by : Robert A. Griffith

Download or read book Ahla Fraud and Abuse Investigations Handbook for the Healthcare Industry written by Robert A. Griffith and published by . This book was released on 2014 with total page 774 pages. Available in PDF, EPUB and Kindle. Book excerpt: If you are not an AHLA member and would like to purchase this title, click here. Understanding the powers, procedures and remedies available to the government during a health care fraud and abuse investigation, and acquiring a basic understanding of the issues and practical steps to employ during an audit or investigation, are keys to surviving the investigation and achieving a favorable outcome. This new Handbook will arm health care administrators, executives, medical directors, office managers, physicians, and medical practice managers with a broad understanding of this industry- specific area of government enforcement. The resource is complete with: * Clear and concise explanations of the law * Sample government documents, affidavits, and subpoenas accompanying each chapter * Illustrative pleadings and memoranda prepared by prosecutors and defense attorneys The authors detail the nuts and bolts of a fraud and abuse investigation, from an overview of the various federal and state enforcement agencies to the potential of settling a case. Learn what to expect and how to respond with coverage of: * Requests to examine books and records dealing with an organization's programs and operations * Interviews of employees by the OIG or the FBI * The power of HIPAA administrative subpoenas and the broad authority granted under this statute * Steps that should be taken in responding to the government's request * Dealing with on-site demands for records and access * Internal audits and investigations * Voluntary disclosures * Affirmative actions to try and fend off an investigation, plea agreements, and deferred prosecution

Healthcare Fraud and Abuse Introduction Manual

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Author :
Publisher : University of Health Care
ISBN 13 : 9781594910227
Total Pages : 0 pages
Book Rating : 4.9/5 (12 download)

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Book Synopsis Healthcare Fraud and Abuse Introduction Manual by : Daniel Farb

Download or read book Healthcare Fraud and Abuse Introduction Manual written by Daniel Farb and published by University of Health Care. This book was released on 2004 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Useful for Doctors, Nurses, Dentists, Therapists, Podiatrists, Osteopaths, Physicians Assistants, Practice Administrators, Compliance Officers, and all Allied Health Professionals, for Medicare, Medicaid, and Private Insurance.