Course Benefits

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:

• Nature and types of healthcare/insurance frauds.
• Healthcare/Insurance fraud: Implications for prevention, detection, and investigation.
• Healthcare/Insurance fraud in International markets.
• Knowing market players within the healthcare continuum in context with healthcare insurances.
• How to recognize & avoid healthcare/insurance fraud.
• Role of ethics in healthcare/insurance fraud prevention.
• Components of the data mapping and data mining process.
• Health Insurance Portability and Accountability Act (HIPAA) of 1996.
• Audit guidelines in using PHI.
• Healthcare/Insurance Fraud: Penalties & Consequences.
• Normal infrastructure and anomaly tracking systems.
• Data analysis models and clinical content data analysis.
• Data-driven Health decisions in an e – Health environment.
• Analytic tools and audit check lists.
• Electronic Health Records and health offering vulnerabilities.

Who Should Attend?

• All levels of auditors, investigators and prosecutors working in the healthcare/insurance fraud area
• Executive Management of insurance or reinsurance companies and hospitals
• Certified Fraud Examiners (CFE)
• Certified Information Systems Auditors (CISA)
• Insurance Claims Adjudicators
• Special Investigator Unit Directors/Auditors
• Medical Claims Auditors
• Compliance 
• Professionals looking to expand their knowledge of insurance fraud detection and prevention

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