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Fraud and Abuse: What You Can Do

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: January 1998



During AHIMA's National Convention, HIM professionals convened to network and share practical ideas on issues pertaining to fraud and abuse. While most of the participants worked in hospitals, other work settings, including colleges, consulting firms, and government agencies were als....

Is the FCA Effectively Fighting Healthcare Fraud?

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: May 2002


How effective has the False Claims Act (FCA) been in reducing healthcare fraud? A recent six-month study conducted by New Directions for Policy for Taxpayers Against Fraud sought to determine just that.1 What the study found is that the FCA is very effective in fighting fraud and should not be....

Coding Compliance: Practical Strategies for Success

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: January 1998


"Fraud," "abuse," "upcoding," "unbundling," and "compliance" have all become buzzwords in the news media. Eliminating healthcare fraud and abuse has become a top priority for the federal government. Government investigations are on the rise and providers everywhere tremble at the thought of b....

Observation Services Present Compliance Challenges

Author: Prophet-Bowman, Sue

Source: Journal of AHIMA

Publication Date: March 2003


Observation services have been a top fraud and abuse target of the Office of Inspector General (OIG) of the Department of Health and Human Services, primarily due to the complexity of the Medicare billing regulations and the potential for abuse. New regulations regarding reimbursement for thes....

Fraud Management: a $100 Billion Bonus from Health IT?

Author: Kloss, Linda L

Source: Journal of AHIMA

Publication Date: March 2006


The financial losses from healthcare fraud in the US are staggering...and growing. Fraud was estimated to be between 3 and 10 percent of total health expenditures in 2003, or $51 to $170 billion, according to the National Health Care Anti-Fraud Association. Whether an interconnected health IT....

In Pursuit of Healthcare Fraud

Author: King, Ellen

Source: Journal of AHIMA

Publication Date: January 1999


How broad is the scope of healthcare fraud and abuse? Here's a look at the many ways the Federal Bureau of Investigation is tackling the problem.

Healthcare fraud takes billions of dollars away from federally funded healthcare programs. These programs, particularly Medicare and Med....

Benchmarks as the Signposts Along the Fraud Case Trail

Author: Kaldal, Karen

Source: Journal of AHIMA

Publication Date: November 1998


Traditionally, payers in the healthcare industry have relied on external tips or complaints for starting points for fraud investigations. But recently the number of leads on fraud activity has increased as the public becomes more aware of the issue. To combat this problem, payers have begun to....

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