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      Chapter

      Fraud
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      Chapter

      Fraud

      DOI link for Fraud

      Fraud book

      Government and Private Sponsored Health Plans and General Case Evaluations

      Fraud

      DOI link for Fraud

      Fraud book

      Government and Private Sponsored Health Plans and General Case Evaluations
      ByRebecca Mendoza Saltiel Busch
      BookLegal Nurse Consulting Principles and Practices

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      Edition 4th Edition
      First Published 2019
      Imprint Routledge
      Pages 36
      eBook ISBN 9780429283642
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      ABSTRACT

      Fraud is defined as an intentional deception resulting in injury to another. Assessment of fraud within a health plan is complex. This chapter will focus on distinguishing normal behavior patterns from those potentially fraudulent and which should trigger a more thorough review. Materials and data appropriate for such a review are discussed and applied to various scenarios. Appropriate guidelines for drawing conclusions from the information and materials reviewed are presented. After a review of this chapter, the legal nurse consultant will have a fundamental guide and standardized approach for the evaluation of cases involving potential fraud or abuse within a government or private sponsored healthcare benefit plan.

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