HEALTHCARE INSURANCE FRAUD
Using technology to prevent and detect billing and claims fraud
Date: 18 – 21 August 2020
Venue: HB Connect Conference Center
Location: Sandton Johannesburg
Register Now, Limited Seats Available!
R 15,999.00 per Delegate
The issues of corruption and fraudulent claims remain some of the biggest challenges the sector continues to face. Medical insurance fraud is, in particular, attracting increasing attention. Some industry experts are pointing to it as a key cause of escalating losses in the medical insurance sector. And while it’s hard to quantify the full extent of the problem, it’s clear that it’s having a negative impact on the industry.
Join us for this highly informative training with an all-inclusive understanding of the scope of healthcare insurance fraud, ranging from the simplest situations to complex and sophisticated healthcare/insurance fraud crimes.
By the end of course, specifically, the attendees will have the know-how to:
- Nature and types of healthcare/insurance frauds.
- Healthcare/Insurance fraud: Implications for prevention, detection, and investigation.
- Healthcare/Insurance fraud in International markets.
- Knowing market players within the healthcare continuum in context with healthcare insurances.
- How to recognize & avoid healthcare/insurance fraud.
- Role of ethics in healthcare/insurance fraud prevention.
- Components of the data mapping and data mining process.
- Health Insurance Portability and Accountability Act (HIPAA) of 1996.
- Audit guidelines for using PHI.
- Healthcare/Insurance Fraud: Penalties & Consequences.
- Data analysis models and clinical content data analysis.
- Data-driven Health decisions in an e-Health environment.
- Analytic tools and audit checklists.
- Electronic Health Records and health offering vulnerabilities.
This Program is Suitable for:-
All levels of auditors, investigators, and prosecutors working in the healthcare/insurance fraud area
- Executive Management of insurance or reinsurance companies and hospitals
- Certified Fraud Examiners (CFE)
- Certified Information Systems Auditors (CISA)
- Insurance Claims Adjudicators
- Special Investigator Unit Directors/Auditors
- Medical Claims Auditors
- Accountants, auditors, attorneys and investigators who service health care industry clients
- Government investigators charged with identifying fraud or noncompliance with government-funded health care facilities and efforts
- Internal auditors for hospitals, medical offices, and other health care organizations
- Public-sector investigators
- Certified Fraud Examiners and other anti-fraud professionals