Health Care Fraud and Abuse


Book Description

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.







Fraud Prevention and Detection


Book Description

Lessons can be learned from major fraud cases. Whether the victim is a company, public agency, nonprofit, foundation, or charity, there is a high likelihood that many of these frauds could have been prevented or detected sooner if early Red Flag warning signs had been identified and acted upon. Fraud Prevention and Detection: Warning Signs and the




Corporate Fraud Handbook


Book Description

Delve into the mind of a fraudster to beat them at their own game Corporate Fraud Handbook details the many forms of fraud to help you identify red flags and prevent fraud before it occurs. Written by the founder and chairman of the Association of Certified Fraud Examiners (ACFE), this book provides indispensable guidance for auditors, examiners, managers, and criminal investigators: from asset misappropriation, to corruption, to financial statement fraud, the most common schemes are dissected to show you where to look and what to look for. This new fifth edition includes the all-new statistics from the ACFE 2016 Report to the Nations on Occupational Fraud and Abuse, providing a current look at the impact of and trends in fraud. Real-world case studies submitted to the ACFE by actual fraud examiners show how different scenarios play out in practice, to help you build an effective anti-fraud program within your own organization. This systematic examination into the mind of a fraudster is backed by practical guidance for before, during, and after fraud has been committed; you'll learn how to stop various schemes in their tracks, where to find evidence, and how to quantify financial losses after the fact. Fraud continues to be a serious problem for businesses and government agencies, and can manifest in myriad ways. This book walks you through detection, prevention, and aftermath to help you shore up your defenses and effectively manage fraud risk. Understand the most common fraud schemes and identify red flags Learn from illustrative case studies submitted by anti-fraud professionals Ensure compliance with Sarbanes-Oxley and other regulations Develop and implement effective anti-fraud measures at multiple levels Fraud can be committed by anyone at any level—employees, managers, owners, and executives—and no organization is immune. Anti-fraud regulations are continually evolving, but the magnitude of fraud's impact has yet to be fully realized. Corporate Fraud Handbook provides exceptional coverage of schemes and effective defense to help you keep your organization secure.




Healthcare Fraud


Book Description

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.




Healthcare Fraud, Corruption and Waste in Europe


Book Description

The lack of well-documented, factual information on fraud, waste and corruption in the healthcare sector is an important ally for those who would seek to abuse healthcare systems for their own profit. Our lack of knowledge of the incidence, nature and extent of fraud, waste and corruption in healthcare is a threat to the establishment of effective counter-fraud strategies. It prevents those who finance healthcare provision from understanding in clear and quantifiable terms the need to invest resources into counter-fraud activities. As a consequence, fraud remains a matter of moral hazard and healthcare systems continue to suffer considerable financial damage, as well as all the associated consequences for the quality of care that patients receive. It was for these reasons that the 'European Healthcare Fraud and Corruption Network' (EHFCN) and the 'Dutch Healthcare Authority' (NZa, member of EHFCN) decided to collaborate to publish this book... --




Occupational Fraud and Abuse


Book Description




Profiling The Fraudster


Book Description

Detect and combat corporate fraud with new profiling techniques Profiling the Fraudster: Removing the Mask to Prevent and Detect Fraud takes a step-by-step approach beyond the Fraud Triangle to identify characteristics in potential fraudsters, employees and new hires that will sound alarm bells before they get their hands on your organization's assets. The typical organization loses a staggering 5% of its annual revenue to fraud. Traditional fraud investigations focus on the breakdown of internal controls but what happens when the human beings forming a key component of that chain of control are inherently dishonest? This book shows you how to recognize the characteristics and behavioral patterns of potential fraudsters who are entrusted with safeguarding corporate assets. The book includes: An in-depth look at fraud investigation techniques and how these can be enhanced by using the characteristics of fraudulent behavior, A detailed look at profiling potential perpetrators of fraud, A detailed breakdown of how to compile a fraud profile, A discussion of a wide range of organizational fraud, including abuse of power, embezzlement, computer fraud, expense abuse, and more, Tables, illustrations, and diagrams to enhance the narrative If you're a corporate fraud investigator, auditor, forensic accountant, law enforcement professional, or anyone challenged with safeguarding your organizations assets—Profiling the Fraudster shows you how to remove the mask and prevent and detect fraud.




Elder Abuse Prevention


Book Description

"I found this book to be informative, well-researched, and well-thought out...The book is an asset to students, scholars, and seasoned practioners alike." --International Perspectives in Victimology "Lisa Nerenberg provides the first comprehensive look at elder abuse prevention trends and strategies. Drawing from existing models and examining salient factors, she outlines approaches to intervention that consider victims and perpetrators and engage communities and service systems. She also offers meaningful response to the many challenges endemic to elder abuse work. As a result, Lisa gives hope to the field." "Beginning as a grassroots advocate a quarter century ago in San Francisco, Lisa developed and tested many viable elder abuse prevention programs herself through the local elder abuse network before exploring best practices elsewhere. This unique evolution and perspective gives her the depth and breadth of understanding needed to write a book like this, able to resonate equally with adult protective service workers struggling to manage caseloads of vulnerable elders, law enforcement personnel trying to prosecute abusers, and academics searching for effective responses to the problem."-- --Georgia J. Anetzberger, PhD, ACSW Assistant Professor of Health Care Administration at Cleveland State University and Editor of the Journal of Elder Abuse & Neglect Recipient of the Legal Assistance for Seniors' "Leading the Fight for Seniors' Rights" annual award for 2007! Drawing from over twenty years of experience helping communities improve their response to elder abuse, Lisa Nerenberg describes what agencies, communities, tribes, states, and national organizations are doing to prevent abuse, treat its effects, and ensure justice. She further explores what remains to be done and offers a plan for the future. In doing so, she addresses the broader challenges of fortifying the long-term care, protective service, and legal systems to meet the new and imminent demands of a burgeoning elderly population. In short, the book is about making communities safer places to grow old. Ms. Nerenberg begins by exploring trends that have shaped or defined practice in the field of elder abuse prevention including the Supreme Court's Olmstead decision; a shift in focus from protecting to empowering victims; an increasingly multicultural elderly population; the "globalization" of the field; and heightened understanding of the "psychology of victimization" (or why victims do what they do and perhaps more importantly, why they often don't do what professionals think they should). She further describes eight models and theories on which practice has been based ranging from the widely recognized adult protective service and domestic violence prevention models to lesser-known approaches such as the family preservation and restorative justice models. She describes specific interventions and approaches that each model has contributed, their benefits and limitations, what is known about their impact, and factors that dictate what responses are appropriate to specific settings and situations. In addition to describing techniques used by individual practitioners, the author outlines strategies and services that agencies, communities, states, tribes, courts, and national organizations have designed, which include elder forensics centers, elder courts, family justice centers, elder shelters, "hybrid" multidisciplinary teams, fraud prevention programs, support groups, restorative justice programs, and culturally specific outreach campaigns. She details progressive public policy initiatives, which range from statutes that provide for the mandatory reporting of deaths in nursing homes, to efforts to improve the collection and distribution of restitution, to laws that address the role of undue influence in elder abuse.