Statistics and Health Care Fraud

Statistics and Health Care Fraud
Author: Tahir Ekin
Publisher: CRC Press
Total Pages: 142
Release: 2019-02-07
Genre: Mathematics
ISBN: 1315278235

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Statistics and Health Care Fraud: How to Save Billions helps the public to become more informed citizens through discussions of real world health care examples and fraud assessment applications. The author presents statistical and analytical methods used in health care fraud audits without requiring any mathematical background. The public suffers from health care overpayments either directly as patients or indirectly as taxpayers, and fraud analytics provides ways to handle the large size and complexity of these claims. The book starts with a brief overview of global healthcare systems such as U.S. Medicare. This is followed by a discussion of medical overpayments and assessment initiatives using a variety of real world examples. The book covers subjects as: • Description and visualization of medical claims data • Prediction of fraudulent transactions • Detection of excessive billings • Revealing new fraud patterns • Challenges and opportunities with health care fraud analytics Dr. Tahir Ekin is the Brandon Dee Roberts Associate Professor of Quantitative Methods in McCoy College of Business, Texas State University. His previous work experience includes a working as a statistician on health care fraud detection. His scholarly work on health care fraud has been published in a variety of academic journals including International Statistical Review, The American Statistician, and Applied Stochastic Models in Business and Industry. He is a recipient of the Texas State University 2018 Presidential Distinction Award in Scholar Activities and the ASA/NISS y-Bis 2016 Best Paper Awards. He has developed and taught courses in the areas of business statistics, optimization, data mining and analytics. Dr. Ekin also serves as Vice President of the International Society for Business and Industrial Statistics.

Healthcare Fraud

Healthcare Fraud
Author: Rebecca S. Busch
Publisher: John Wiley & Sons
Total Pages: 374
Release: 2012-05-01
Genre: Business & Economics
ISBN: 1118179803

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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.

Statistics and Health Care Fraud

Statistics and Health Care Fraud
Author: Tahir Ekin
Publisher: CRC Press
Total Pages: 142
Release: 2019-02-07
Genre: Mathematics
ISBN: 1315278243

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Statistics and Health Care Fraud: How to Save Billions helps the public to become more informed citizens through discussions of real world health care examples and fraud assessment applications. The author presents statistical and analytical methods used in health care fraud audits without requiring any mathematical background. The public suffers from health care overpayments either directly as patients or indirectly as taxpayers, and fraud analytics provides ways to handle the large size and complexity of these claims. The book starts with a brief overview of global healthcare systems such as U.S. Medicare. This is followed by a discussion of medical overpayments and assessment initiatives using a variety of real world examples. The book covers subjects as: • Description and visualization of medical claims data • Prediction of fraudulent transactions • Detection of excessive billings • Revealing new fraud patterns • Challenges and opportunities with health care fraud analytics Dr. Tahir Ekin is the Brandon Dee Roberts Associate Professor of Quantitative Methods in McCoy College of Business, Texas State University. His previous work experience includes a working as a statistician on health care fraud detection. His scholarly work on health care fraud has been published in a variety of academic journals including International Statistical Review, The American Statistician, and Applied Stochastic Models in Business and Industry. He is a recipient of the Texas State University 2018 Presidential Distinction Award in Scholar Activities and the ASA/NISS y-Bis 2016 Best Paper Awards. He has developed and taught courses in the areas of business statistics, optimization, data mining and analytics. Dr. Ekin also serves as Vice President of the International Society for Business and Industrial Statistics.

Healthcare Fraud, Corruption and Waste in Europe

Healthcare Fraud, Corruption and Waste in Europe
Author: Misja Mikkers
Publisher:
Total Pages: 0
Release: 2017
Genre: Europe
ISBN: 9789462366855

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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... --

Crossing the Global Quality Chasm

Crossing the Global Quality Chasm
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
Total Pages: 399
Release: 2019-01-27
Genre: Medical
ISBN: 0309477891

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In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.

Health Care Fraud and Abuse

Health Care Fraud and Abuse
Author: Aspen Health Law Center
Publisher:
Total Pages: 156
Release: 1998
Genre: Business & Economics
ISBN:

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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.

Healthcare Fraud Investigation Guidebook

Healthcare Fraud Investigation Guidebook
Author: Charles E. Piper
Publisher: CRC Press
Total Pages: 230
Release: 2017-07-27
Genre: Law
ISBN: 1498752616

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Some have estimated that healthcare fraud in the United States results in losses of approximately $80 billion a year. Although there are many books available that describe how to "detect" healthcare fraud, few address what must be done after the fraud is detected. Filling this need, Charles Piper‘s Healthcare Fraud Investigation Guidebook details n

Intelligent Systems for Finance and Business

Intelligent Systems for Finance and Business
Author: Suran Goonatilake
Publisher:
Total Pages: 360
Release: 1995
Genre: Business & Economics
ISBN:

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Intelligent Systems for Finance and Business Edited by Suran Goonatilake and Philip Treleaven A new generation of computing methods, commonly known as ‘intelligent systems’ are now beginning to be successfully applied in a variety of business and financial modelling tasks, and in many cases are outperforming traditional statistical techniques. Intelligent Systems for Finance and Business provides comprehensive coverage of the latest intelligent systems including genetic algorithms, neural networks, fuzzy logic, expert systems, rule induction, genetic programming, case based reasoning and intelligent hybrid systems. The authors clearly illustrate theories with practical case studies drawn from a wide variety of business sectors such as: • credit evaluation • direct marketing • insider dealing detection • insurance fraud detection • insurance claims processing • financial trading • portfolio management • economic modelling Written by leading professionals from the US, Europe and Asia who have developed intelligent systems to tackle some of the most challenging problems in finance and business, this book will be a valuable source of information for traders, analysts, researchers and computing personnel in investment banking, retailing, marketing, financial services, insurance and regulation.

Tackling Wasteful Spending on Health

Tackling Wasteful Spending on Health
Author: OECD
Publisher: OECD Publishing
Total Pages: 306
Release: 2017-01-10
Genre:
ISBN: 9264266410

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Countries could potentially spend significantly less on health care with no impact on health system performance, or on health outcomes. This report reviews strategies put in place by countries to limit ineffective spending and waste.

Trillion Dollar Scam

Trillion Dollar Scam
Author: Saul William Seidman
Publisher: Universal-Publishers
Total Pages: 200
Release: 2008
Genre: Business & Economics
ISBN: 159942956X

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Fraud is the result of government and insurance company control of health care. The growth of bureaucracy is a precursor to incompetence and soaring costs of medical care. A lack of clinical diagnosis and a dependence on expensive testing has increased costs while decreasing the doctor's competence. The FBI and the attorneys general of all states are dealing with exploding health care fraud. The result is a trillion dollars in waste and deception. Trillion Dollar Scam details the origin of this fraud and waste, and offers solutions to fixing the broken U.S. health care system.