RN, MBA, CCM, CFE, CPC, CHS-111, CRMA, CICA, FIALCP, FHFMA
CEO, Medical Business Associates, Inc.
Book Author of “Healthcare Fraud: Auditing & Detection Guide”
Faculty member of the Association of Certified Fraud Examiners
When Willie Sutton, an infamous twentieth-century bank robber, was asked why he robbed banks, he replied, “Because that’s where the money is.’’ The healthcare industry, too, has lots of money – estimated to be a $2.9 trillion industry in 2015. How many of these annual healthcare/insurance dollars are attributed to fraud? About $25 million per hour is stolen in healthcare in the United States alone. So, it’s a mounting problem and the impact is only going to grow.
This course will provide the investigative professionals with thorough knowledge of medical and healthcare/insurance fraud in both the private and government sectors particularly in context with the Middle East region. The participants will learn scams committed by claimants and providers, the effects of this type of fraud, red flags for fraud recognition, and investigative tips.
This course is designed to introduce the healthcare/insurance industry: a highly segmented market with high-dollar cash transactions, from a fraud, audit, and detection perspective. This course also teaches “what is normal” in the marketplace so that abnormalities become apparent. Healthcare/insurance fraud prevention, detection, and investigation methods are outlined, as are different types of healthcare schemes, red flags to spot these schemes, and how Healthcare/Insurance fraud is ultimately stopped.
The ultimate goal is to encourage participates to see beyond the eclipse created by healthcare/insurance fraud and sharpen audit and investigation skills to identify incontrovertible truth.
Completion of this course will provide attendees with an all-inclusive understanding of the scope of healthcare insurance fraud, ranging from the simplest situations to complex and sophisticated healthcare/insurance fraud crimes.
By the end of course, specifically, the attendees will have the know-how to:
All levels of auditors, investigators and prosecutors working in the healthcare/insurance fraud area
Book & pay on or before Jan. 25th, 2018 & get
10% addtional discount USD 1,885/participant
Corporate (Group Discount)
10% Discount on minimum of 3 Participants
Registration and Intro
I. Introduction to Healthcare/Insurance fraud
II. Defining Market Players within the Healthcare Continuum
III. Protected Health Information
IV. Health Information Pipelines
V. Accounts Receivable Pipelines
VI. Operational Flow Activity
VII. Product, Service, and Consumer Market Activity
VIII. Data Management
IX. National Infrastructure
X. Normal Infrastructure and Anomaly Tracking Systems
XI. Components of the Data Mapping Process
XII. Components of the Data Mining Process
XIII. Components of the Data Mapping and Data Mining Process
XIV. Data Analysis Models
XV. Clinical Content Data Analysis
XVII. Market Implications
I. Market Background
II. Industry Applications
III. Impact of E – Health on Case Management
IV. Data in an E – Health Environment
VI. Data-driven Health Decisions in an E – Health Environment
VII. Analytic Tools and Audit Checklists
VIII. Electronic Health Records
IX. Healthcare Portfolio
|08:00 to 08:30||Registration & Introduction|
|08:30 to 10:00||Session One|
|10:00 to 10:15||Morning Break & Networking|
|10:15 to 12:15||Session Two|
|12:15 to 13:15||Lunch Break & Networking|
|13:15 to 14:45||Session Three|
|14:45 to 15:00||Evening Break & Networking|
|15:00 to 16:30||Session Four|