Healthcare Fraud Investigation Guidebook

Some have estimated that healthcare fraud in the United States results in losses of approximately $80 billion a year. Although there are many books available that describe how to "detect" healthcare fraud, few address what must be done after the fraud is detected. Filling this need, Charles Piper’s Healthcare Fraud Investigation Guidebook details not only how to detect healthcare fraud, but also how to "investigate" and prove the wrongdoing to increase the likelihood of successful prosecution in court.The book starts by covering the history of healthcare insurance and the various types of fraud schemes. It presents Charles Piper’s unique approach to investigating (The Piper Method) which allows readers to conduct as many as 10 simultaneous investigations for each case. It emphasizes the importance of simultaneously searching for waste and abuse as well as systemic weaknesses and deficiencies that caused or contributed to the problem or wrongdoing under investigation and then make recommendations for improvement. It also provides: Questions to ask whistleblowers, complainants, employers, employees, and healthcare providers who are suspects Tips on investigative case planning, goals, and strategies Sample visual aids for use when briefing others about your investigative findings Guidance on presenting information obtained from healthcare investigations and on how to testify in court Techniques for uncovering previously undetected fraud The book includes a sample case study that walks readers through a mock case—from the time the case is received through the end. The case study demonstrates how to initiate, plan, and conduct a thorough and complete healthcare fraud investigation while incorporating Piper’s proven methodology.Sharing insights gained through Charles Piper’s decades of experience as a federal special agent and certified fraud examiner, the Healthcare Fraud Investigation Guidebook aims to revolutionize the way that healthcare fraud investigations are conducted. It provides the understanding you need to not only put a bandage on the problem of healthcare fraud, but to actually start curing the greed that is poisoning the healthcare industry.

Preface. Acknowledgements. About the Author. BACKGROUND ON HEALTHCARE INSURANCE & RELATED FRAUD. TWENTY COMMON HEALTHCARE PROVIDER FRAUD SCHEMES. OTHER HEALTHCARE FRAUDSTERS & SCHEMES. VICTIMS, INVESTIGATORS, COMPLAINANTS, LAWS & STATUTES. CODES, NUMBERS, FORMS & DOCUMENTS. INVESTIGATIVE SOURCES & RESOURCES. INVESTIGATIVE TOOLS & TECHNIQUES. INTERVIEWS & INTERROGATIONS. INVESTIGATIVE REPORTS & EVIDENCE. INVESTIGATIVE CASE PLANNING, GOALS & STRATEGY. CASE PRESENTATIONS & TESTIFYING. POST ADJUDICATIVE ACTION. SAMPLE CASE STUDY UTILIZING THE "PIPER METHOD". Conclusion. Samples (Slides) of Case Presentation Visual Aids.

Charles E. Piper, CFE, CRT, is an award-winning investigator and author. He served for more than 30 years in law enforcement, including 20 years as a special agent–criminal investigator with the Department of Defense, where he conducted major fraud investigations from coast to coast. Piper has investigated numerous healthcare providers and others for fraud and worked jointly with federal special agents from the FBI and the many Offices of Inspector General. His investigations have resulted in millions of dollars in recoveries and criminal convictions and civil judgments against fraudsters. He is also a proud veteran of the U.S. Army.Piper is currently the owner of Charles Piper’s Professional Services in West Tennessee, which provides investigative, consulting, and training services. He is a Certified Fraud Examiner (CFE), Certified in the Reid Technique of Interview and Interrogation (CRT), and a graduate of three law enforcement investigative academies (federal, state, and military).Piper has received numerous awards and recognition while serving in law enforcement, including Special Agent of the Year. Since opening his own company, Piper was the recipient of the 2014 Association of Certified Fraud Examiners’ (ACFE) Hubbard Award. He has written several antifraud and investigative articles for the ACFE’s Fraud Magazine and other publications.