Investigating Private & Governmental Health Care Fraud


RVACFES 75 – Investigating Private & Governmental Health Care Fraud  – 2 CPE –  To purchase this lecture add it to your Cart and follow the on-screen instructions …



For years, a powerful force has been undermining both the public and private sectors of our economy, wreaking havoc on corporate profits and on the expenditure of taxpayer dollars alike. Its monetary damage is  immense, exceeding the annual revenue of many Fortune 500 companies and nearly equaling the gross domestic product of Switzerland. And while neither a country nor a company, this growing menace has a significant impact on both – it’s a scourge known as U.S. health-care fraud. The ACFE estimates losses due to fraud in both public and private health-care spending amount to more than US $6o billion annually. By definition, health-care fraud involves deception or misrepresentation that results in an unauthorized benefit. It increases the cost of providing benefits to Medicare and Medicaid beneficiaries and to private employees company-wide, which in turn increases the overall cost of doing business – regardless of industry. And while only a slight percentage of health-care providers and consumers deliberately engage in fraud, that small amount can raise costs significantly. The  increased costs appear in the form of higher premiums and out-of-pocket expenses or reduced benefits or coverage for employees. This lecture introduces the fraud examiner to the spectrum of health care fraud and includes an overview of the most common provider and recipient schemes encountered by investigators.

120 minutes of self  study plus  10 minutes to answer 10 questions for a total of  130 minutes.

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