Detecting Fraud & Abuse Case Study HW

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

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.