- NY Credits : 4.0
- TX Credits : 4.0
The healthcare system in the United States is arguably the best in the world, but it is constantly vulnerable to waste, fraud, and abuse. This program will provide an overview of the current United States healthcare system; give estimated fraud costs; and list useful definitions for physicians. It will offer insight into how criminal investigations are initiated and assembled by law enforcement and prosecutorial agencies. It will also outline steps to protect a physician's practice from fraud schemes and review audit requirements when designing and implementing a fraud prevention strategy.
Upon successful completion of Fraud Prevention for Physicians, the user should be able to:
identify the overall response of the U.S. Government to the healthcare fraud problem,
recognize the concepts of criminal intent; to act knowingly; to act willingly; to act with good faith; to act intentionally; and motive,
select a common framework for fraud investigations,
identify common steps taken by investigators once allegations of fraud are confirmed,
provide some initial steps to consider when designing systems to protect physician practices,
recognize how thieves use knowledge of business and accounting to perpetrate and conceal fraud schemes,
identify the interview process,
recognize the importance of the Committee of Sponsoring Organizations of the Treadway Commission (COSO), and
recognize the audit requirements.