This course provides an overview of the False Claims Act, the Qui Tam action, and Stark Laws, within an overall framework of the prevention of fraud, abuse and waste primarily within the Medicare and Medicaid programs, as well as private healthcare plans. The course includes comprehensive guidance on the methods through which healthcare plans conduce auditing and fraud detection, with advice on the development and implementation of an internal audit and fraud detection program to prevent violations of healthcare plan policies. The course reviews data mapping and data mining as tools to maximize the effectiveness and efficiency of fraud investigations. Class discussions take the perspective of clinical practice, research, internal auditor and compliance officer. Cases and methodologies are provided to demonstrate actual auditing and investigative tools.
Syllabus: The current course syllabus is available to enrolled students only.