Healthcare Fraud Investigation Guidebook

Zusatztext "Investigating healthcare fraud is a challenge for both the rookie and experienced investigator. Success requires knowledge of how our healthcare system works and of the broad range of potential fraud schemes unique to healthcare, along with solid investigative techniques and skills. Charles Piper's excellent book, Healthcare Fraud Investigation Guidebook covers all of these topics and more, providing investigators with the practical information they need to meet the challenge. A copy of Charles Piper's Healthcare Fraud Investigation Guidebook should be on every healthcare fraud investigator's desk." Louis Saccoccio, JD, Chief Executive Officer, National Health Care Anti-Fraud Association "Healthcare fraud is so enormous that no one can accurately estimate what the total cost is. And, it costs all of us. Everyone reading this sentence is the victim of healthcare fraud through higher medical fees, increased premiums, and tax hikes. I am grateful that an experienced fraud examiner such as Charles Piper has taken the time to share his extensive knowledge and experience so that others can join him in the fight to reduce this massive epidemic." James D. Ratley, Chief Financial Officer, Chief Executive Officer, and President, Association of Certified Fraud Examiners "Healthcare fraud is costing money and lives. Charles Piper's Healthcare Fraud Investigation Guidebook exposes the problem and provides tested methods to investigate healthcare shenanigans . 'The Piper Method' of conducting thorough and complete investigations needs to become the preventive remedy that cures the greed that is poisoning the healthcare industry." Scott Amey, JD, General Counsel, Project On Government Oversight (POGO) "Whether you are working your first healthcare fraud case, or you are an experienced veteran, the Healthcare Fraud Investigation Guidebook by Charles E. Piper, CFE, will be your lifeline to a thorough, organized, and successful inquiry. Piper shares his decades of expertise to help you identify the fraud schemes and the investigative strategies used to best uncover them. Far more than an introduction to the topic, it is an encyclopedia on how healthcare fraud works, how to get to the bottom of it, and of particular value, how to look for fraud patterns so your investigations might be expanded beyond single providers and other wrongdoers. This book should be required reading for any fraud fighter investigating healthcare fraud." Gilbert R. Jimenez, JD, CIG, LPD, Licensed Illinois Private Investigator; Principal, Insight Investigation Services of Chicago, Illinois; Attorney and Former Deputy Inspector General, Illinois "Charles Piper's Healthcare Fraud Investigation Guidebook should be considered the go-to book for investigating healthcare fraud. His shared detailed investigative approach will help investigators to not only identify healthcare fraud, waste, and abuse but to also connect the dots and identify more fraud and more wrongdoers and then make recommendations for improvement to prevent reoccurrences. Piper's thorough and complete investigative methodology should be the standard practice for all investigators and investigative agencies and organizations. Taxpayers and all who pay insurance premiums will also be delighted that this revolutionary approach is being utilized to help make healthcare more affordable." Bruce Durbin, (Retired) Federal Special Agent, U.S. Department of Homeland Security "I worked closely with Charles Piper when we served as federal agents with the Defense Criminal Investigative Service. He is the consummate professional. Piper's Healthcare Fraud Investigation Guidebook is a great tool and resource for those responsible for investigating and prosecuting healthcare fraud. I highly recommend it." Rich...

Auteur

Charles E. Piper

Texte du rabat

Although many books 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 not only how to detect healthcare fraud, but also how to "investigate" and prove the wrongdoing to increase the likelihood of successful prosecution. The book includes a sample case study that walks readers through a mock case from the time the case was received through the end. It illustrates how to initiate, plan, and conduct a thorough and complete healthcare fraud investigation while incorporating Piper's unique methodology.

Résumé

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 not only how to detect healthcare fraud, but also how to "investigate" and prove the wrongdoing to increase the likelihood of successful prosecution in court.

The book starts by covering the history of healthcare insurance and the various types of fraud schemes. It presents Charles Piper's unique approach to investigating (The Piper Method) which allows readers to conduct as many as 10 simultaneous investigations for each case. It emphasizes the importance of simultaneously searching for waste and abuse as well as systemic weaknesses and deficiencies that caused or contributed to the problem or wrongdoing under investigation and then make recommendations for improvement. It also provides:

• Questions to ask whistleblowers, complainants, employers, employees, and healthcare providers who are suspects
• Tips on investigative case planning, goals, and strategies
• Sample visual aids for use when briefing others about your investigative findings
• Guidance on presenting information obtained from healthcare investigations and on how to testify in court
• Techniques for uncovering previously undetected fraud The book includes a sample case study that walks readers through a mock casefrom the time the case is received through the end. The case study demonstrates how to initiate, plan, and conduct a thorough and complete healthcare fraud investigation while incorporating Piper's proven methodology.

Sharing insights gained through Charles Piper's decades of experience as a federal special agent and certified fraud examiner, the Healthcare Fraud Investigation Guidebook aims to revolutionize the way that healthcare fraud investigations are conducted. It provides the understanding you need to not only put a bandage on the problem of healthcare fraud, but to actually start curing the greed that is poisoning the healthcare industry.

Contenu
Preface, Acknowledgments, Author, Chapter 1. Background on healthcare insurance and related fraud, Chapter 2. Twenty common healthcare provider fraud schemes, Chapter 3. Other healthcare fraudsters and schemes, Chapter 4. Victims, investigators, complainants, laws, and statutes, Chapter 5. Codes, numbers, forms, and documents, Chapter 6. Investigative sources and resources, Chapter 7. Investigative tools and techniques, Chapter 8. Interviews and interrogations, Chapter 9. Investigative reports and evidence, Chapter 10. Investigative case planning, goals, and strategies, Chapter 11. Case presentations and testifying, Chapter 12. Post-adjudicate action, Chapter 13. Sample case study utilizing The Piper Method, Conclusion, Appendix