Fraud, Waste, and Abuse for Healthcare Administrators

Catalog description

Fraud, Waste, and Abuse (FWA) in the United States is unfortunately highly pervasive and extremely detrimental to all facets of health care delivery. This special topic, Fraud, Waste, and Abuse for Healthcare Administrators, focuses on real-world situations and examples which illustrate how destructive these activities are to providers, payers, and, most importantly, patients. This course will focus on a different topic each week to assist the student in understanding (1) where the nearly 25% of all erroneous medical payments occur, (2) why so much money is lost to fraud, waste and abuse each year, and (3) how different analytic and investigative techniques are best applied to help regulate these issues. In addition to the reading and examples provided in class, students will participate in weekly threaded discussions and chat. Students also learn how to conduct a health care fraud investigation through applying techniques learned in this course to a fictional case. This course covers FWA from two perspectives: (1) statistical and analytical processes to identify potential FWA and (2) investigation techniques to impede future FWA.