This book will provide comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans. The chapters are as follows: (1) Introduction: Healthcare Fraud, (2) Anomaly Tracking System, (3) Components to the Data Mapping Process, (4) Components to the Data Mining Process, (5) Critical Elements of Data Mining and Data Mapping, (6) Sample Documents to Collect throughout the Referenced Pipelines, (7) Sample Clinical Content Information to Collect: How to Analyze Written Health Records, (8) Segment Data, (9) Data Mapping Generated by HIP and Profiler, (10) Overview of Analysis Data Integration, (11) Flow Chart Algorithms to Create Systems to look for Healthcare Waste, Fraud, and Abuse, (12) Profilers, (13) Data Mining of Health Information, (14) Market Implications, (15) Conclusion
Book Details:
- Author: Rebecca S. Busch
- ISBN: 9780470227084
- Year Published: 2008
- Pages: 320
- BISAC: BUS003000, BUSINESS & ECONOMICS/Auditing
About the Book and Topic:
This book will provide comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans. The chapters are as follows: (1) Introduction: Healthcare Fraud, (2) Anomaly Tracking System, (3) Components to the Data Mapping Process, (4) Components to the Data Mining Process, (5) Critical Elements of Data Mining and Data Mapping, (6) Sample Documents to Collect throughout the Referenced Pipelines, (7) Sample Clinical Content Information to Collect: How to Analyze Written Health Records, (8) Segment Data, (9) Data Mapping Generated by HIP and Profiler, (10) Overview of Analysis Data Integration, (11) Flow Chart Algorithms to Create Systems to look for Healthcare Waste, Fraud, and Abuse, (12) Profilers, (13) Data Mining of Health Information, (14) Market Implications, (15) Conclusion
Oxford Healthcare estimates that healthcare fraud costs Americans approximately $100 Billion per year. These frauds take place on the vendor, consumer, and employer levels and managing the risks requires an understanding of how the healthcare system works and where the key risk areas are. At the vendor and employer level, there are compliance issues that must be managed including HIPPA privacy requirements.
HOT TOPIC: Forensic accounting continues to be among the leading growth areas in the accounting industry and the healthcare industry is among the hardest hit with an estimated $24 Million dollars lost per hour. AUTHOR SPEAKING AND TRAINING: Author is a faculty member with the ACFE and will use the book in her healthcare fraud training courses. She is also a frequent speaker on the subject. ACFE SUPPORT: The Association of Certified Fraud Examiners will promote and resell the book.
About the Author
Rebecca S. Busch, RN, MBA, CCM, CBM, CHS-III, CFE, FHFMA, (Oak Brook, IL) is President and CEO of Medical Business Associates, Inc. a consulting firm specializing in healthcare audits for employers, hospitals, and insurance companies. She has over 20 years of progressive achievement in the healthcare management industry. She is a faculty member of the Association of Certified Fraud Examiners (ACFE), has published numerous articles, and is a frequent public speaker.