Detecting fraud and abuse

Detecting Fraud & Abuse Case Study

CAHIIM Objective: V.C.1 Identify potential abuse or fraudulent trends through data analysis

Data is being collected from every step of a patient’s visit to their physician or local healthcare facility. From the moment the patient walks in the door to the moment they walk back out of the door, information is being assessed. What has become the latest focus is how we use this data from the industry perspective to make things better whether it be for clinical use or for administrative use. The challenge has become how it is making things better.

In the attached article, the author illustrate how the use of data mining is being used to detect health care fraud and abuse. After reading the article:

· Identify the most important facts as addressed by this article

· Identify the key issues

· Specify alternative courses of actions that healthcare facilities can take

· Recommend the best course of action a facility can take

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