Week 5 DQ

Required Resources:

ISBN: 978-0-07-351371-3

Valerius, J., Bayes, N., Newby, C., Blowchowiak, A. (2012). Medical Insurance, an Integrated Claims Process Approach. (6th Ed.), New York, NY: McGraw-Hill Publishers.

• Chapter 15
• Chapter 16

ISBN: 978-0-7637-5964-3

Valerius, J., Bayes, N., Newby, C., Blowchowiak, A. (2012). Medical Insurance Workbook. New York, NY: McGraw-Hill Publishers.

Week 5 Discussion:

Lead-in:

The Office of the Inspector General, acting in its capacity to combat fraud and abuse, can initiate audit investigations of health insurers as well as health providers. As a professional, you need to be aware of situations that can result in an audit and how healthcare professionals can reduce the probability of an audit.

To Prepare for the Assignment:

• Read Chapters 15 & 16 in Medical Insurance, an Integrated Claims Process Approach
• Review Chapter 2, “Thinking It Through”, Section 2.9 in Medical Insurance, an Integrated Claims Process Approach
• Review this website for areas of fraud and abuse: http://oig.hhs.gov/fraud/state-false-claims-act-reviews/index.asp

With these thoughts in mind:

Post your primary response to DQ1 by Day 3: Choose one (1) example of criteria that might be reviewed by the Office of the Inspector General. Then provide 2-3 ways to prevent any audit concerns. Finally, suggest how your current or future role in healthcare might be able to prevent an audit concern.

Instructions for post: Title of post: Your Name, Audit Concern