Healthcare Fraud
Classes included in this topic area include:
Introduction to Fraud, Waste and Abuse in the U.S. Healthcare Delivery Systems
This course will examine healthcare Fraud, Waste and Abuse (FWA) within healthcare delivery specifically from the patient perspective.
What skills will you gain?
- Articulate why U.S. healthcare delivery is different than other countries
- Identify possible flaws in the US healthcare delivery system
- Describe the patient’s role in healthcare delivery
- Evaluate the importance of the patient’s role among other market players
Introduction to Common Medical Malpractice
Examine the role of the medical provider and the common diagnoses that are used in healthcare fraud.
What skills will you gain?
- Explain the importance coding edits have in preventing/curbing fraud, waste, and abuse
- Analyze the tools available for preventing/curbing fraud, waste, and abuse
- Discuss administrative regulations with respect to fraud, waste, and abuse
Billing Models for Healthcare Fraud
Get an inside look at the legal issues in healthcare fraud and the part the Office of Inspector General (OIG) plays in investigations as you analyze the processing systems of Medicare and Medicaid.
What skills will you gain?
- Evaluate business operations to identify risk areas for fraud
- Analyze financial data to detect irregularities in areas such as billing trends, financial relationships, and regulatory compliance procedures
- Review reports of suspected fraud to determine need for further investigation
- Office suite software — Microsoft Office
Introduction to Healthcare Fraud, Waste and Abuse Trends & Schemes
Each year, as the estimates for FWA losses continue to increase, the challenge of detecting and preventing these schemes also continues to grow. This course will focus on introducing students to the evolution of healthcare and fraud waste and abuse
What skills will you gain?
- Identify the shifts in criminal involvement
- Analyze the difference between the types of perpetrators m
- Describe the similarities of victims of healthcare fraud
- Discuss impacts and outcomes of healthcare fraud