Law Commons^™

Investigating Physicians Billing For Services Not Rendered: Fraud Detection, Interviewing And Referral To Law Enforcement, Glenn Forte Jr.

Economic Crime Forensics Capstones

This qualitative study examines the role of healthcare insurance investigators related to medical fraud among physicians billing for services not rendered. Grounded in academic scholarship, industry case studies and first-hand knowledge, this study introduces methods identifying fraudulent activities, fraud detection practices and implications from discovering fraud among physicians, patients, and health insurance companies. The three types of methodologies employed provide a lens into determining misappropriation of healthcare insurance and patient monetary funds.

Healthcare fraud falls within the arena of white-collar crime. It consists of filing dishonest healthcare claims to receive a profit. Fraudulent healthcare schemes come in many forms. The …