Fraud, Part 1 (An Introduction)

Course Overview

Health insurance providers, managed care organizations, and other health care stakeholders are increasingly tasked with achieving more on shrinking budgets. This places a premium on strategies that combat and deter the financial effects of health care fraud. With Fraud, Part I (Introduction), you’ll gain valuable expertise in detecting, deterring, and reducing health care fraud, to help you do your job even better

Learning Objectives

What You’ll Learn

  • Explore the methods investigators use to uncover and deter fraud against the health care and health insurance industries
  • Compare the different ways fraud schemes work and where they often occur
  • Understand how to identify fraudulent practice
  • Focus on investigative methods at the organizational level, among health care consumers, and in other arenas where fraud can occur
  • Navigate the legal, regulatory, and compliance issues impacting anti-fraud efforts
  • Examine relevant terms, case scenarios, and key concepts

Who Should Take This Course

  • Agents and brokers
  • Claims analysts
  • Compliance officers
  • Corporate counsel
  • Federal regulatory personnel
  • Fraud examiners
  • Health insurance provider staff
  • Legal advisors
  • Privacy officers
  • State regulatory personnel

Module 1: Course Overview

Module 2: Provider Fraud and Abuse

Module 3: Consumer Fraud

Module 4: Agent, Broker, and Employee Fraud

Module 5: Managed Care Fraud

Module 6: Disability Income Insurance Fraud

Module 7: A Summary of Fraudulent Practices

Module 8: The Insurer Anti-Fraud Program

Module 9: The Detection of Fraud

Module 10: Investigation Review of Files and Record

Module 11: Investigation Interviews and Surveillance

Module 12: Investigating Evidence and Reporting

Module 13: The Detection and Investigation of Managed Care Fraud

Module 14: The Detection and Investigation of Disability Fraud

Module 15: Collaborative Anti-Fraud Efforts

Module 16: Laws Against Health Care Fraud

Module 17: Legal Issues Affecting Anti-Fraud Activities

Module 18: Outcomes of Anti-Fraud Activities

Price: $380

This Course includes:

   Text-based content

   5 weeks