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/insurance 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.
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.
Participants who complete the course will get an opportunity to:
Opening Remarks & Introduction
|12:45 to 13:00||Registration & Introduction|
|13:00 to 15:00||Session One|
|15:00 to 15:20||Break (20 minutes)|
|15:20 to 16:20||Session Two|
|16:20 to 16:40||Break (20 minutes)|
|16:40 to 17:40||Session Three|