Download Healthcare Fraud: Auditing and Detection Guide by Rebecca S. Busch PDF

By Rebecca S. Busch

In response to inner most and public estimates, nearly $24 million is misplaced in line with hour to healthcare waste, fraud, and abuse. a must have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud: Auditing and Detection advisor presents tips and methods that will help you spot—and prevent—the "red flags" of fraudulent job inside of your company. Eminently readable, it's your “go-to” source, equipping you with the required abilities to appear for and care for capability fraudulent occasions.

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Compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amount ultimately recovered in actions brought by such insureds 8. Attempting to settle a claim for less than the amount to which a reasonable man would have believed he was entitled by reference to written or printed advertising material accompanying or made part of an application 9. Attempting to settle claims on the basis of an application that was altered without notice to, or knowledge or consent of, the insured 40 chapter 2 defining market players 10.

X 287). This criminal statute applies to any federal government department or agency. The making of fraudulent claims is a felony, and the 1986 amendments to the FCA mandate both a fine and imprisonment for all convictions. In addition to bringing a criminal action, the government may also bring a parallel civil action seeking relief. The FCA affords the private citizen new incentives to report suspected frauds. It also gives whistleblowers extensive protection from harassment and retaliation from employers.

Making known to insureds or claimants a policy of appealing from arbitration awards in favor of insureds or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration 12. Delaying the investigation or payment of claims by requiring an insured, claimant, or the physician of either to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information 13.

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