2015 Annual Training Conference & Anti-Fraud Expo
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Forensic Accounting in Health Care Fraud Investigations
(
Room
Coronado D
)
18 Nov 15
2:15 PM
-
3:15 PM
Tracks:
Fraud Schemes and Investigative Skills
Speaker(s):
Emily Foss, MBA, MAcc, CFE, Special Investigator, Special Investigations Unit, Humana
Health care fraud is a form of white collar crime that is on the rise and costing billions of dollars in the United States. Forensic Accountants are trained to follow money and apply dollars to motive. Typically, there is only one motive in healthcare fraud and that motive is to increase a bank account. The fraud may be perpetuated individually or as a conspiracy with many parties involved. The Forensic Accountant is able to evaluate healthcare fraud from a different perspective, which attaches the dollars to the schemes being perpetuated. The presenter will discuss investigative strategies that assist with "following the money" and making sense of the dollars associated with various schemes. Schemes to defraud versus policy/plan violations will be discussed. A discussion of what constitutes criminal activity will focus on when a provider knowingly and willingly performs an act to increase their bank account.
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