This book brings an unusual opportunity to explore the peculiarities of America's health care industry's approach to fraud control, when compared with the financial services sector, credit card companies, or the Internal Revenue Service—all of which have to defend themselves against fraud.

chapter |16 pages


part One|104 pages

Understanding the Fraud-Control Challenge

chapter 1|21 pages

The Pathology of Fraud Control

chapter 3|21 pages

The Importance of Measurement

chapter 4|27 pages

Assessment of Fraud-Control Systems

chapter 5|18 pages

The Antithesis of Modern Claims Processing

part Two|36 pages

Current Developments

chapter 6|19 pages

Electronic Claims Processing

chapter 7|16 pages

Managed Care

part Three|55 pages

Prescription for Progress

chapter 8|30 pages

A Model Fraud-Control Strategy

chapter 9|24 pages

Detection Systems

chapter |4 pages