The Identification and Impact of Fraudulent Claims in the Insurance Industry

Author

Joyce Christine Rogers, Fontbonne College

Year of Award

1995

Degree

Master of Business Administration (MBA)

College

College of Business & Professional Studies

Degree Program

Master of Business Administration

Department

Business Administration

Keywords

patient, medical, providers, health, records, lab, anti-fraud

Abstract

There is a growing severity of the nation’s healthcare fraud problem and a need to address it effectively through a cooperative approach involving both the private and public sector. Education and practical training in the detection, investigation, prosecution and prevention of healthcare fraud and sharing information among private payers and with law enforcement. Public Policy attention and changes in our healthcare system are influencing anti-fraud activity. Increasingly, state legislatures are mandating certain standards of formal anti-fraud efforts in which health insurers must engage. At the federal level, there is a great likelihood that some meaningful legislation will be enacted. The actual success and impact on fraud activity will be measured longitudinally, over a period of time and demonstrate successful outcomes. Ongoing efforts are important to the curtailment of fraud in order to ensure decreased fraudulent behavior. This paper supports the need for anti-fraud activity and consideration.

Document Type

Restricted Thesis

Recommended Citation

Rogers, Joyce Christine, "The Identification and Impact of Fraudulent Claims in the Insurance Industry" (1995). All Theses, Dissertations, and Capstone Projects. 175.
https://griffinshare.fontbonne.edu/all-etds/175