Question

Watch the following video about Healthcare Fraud and discuss how can you avoid healthcare fraud in a healthcare facility as a healthcare manager?

https://youtu.be/cSCBrenXPao

Answer 1

First of all let's being with what is healthcare fraud -: when a company or an individual defrauds an insurer or government healthcare programme is called as a healthcare fraud . it includes healthcare insurance fraud, drug fraud and medical fraud . As a healthcare manager one needs to apply fundamental healthcare fraud management practices and basic security controls.we need to trace detect and prevent. So how we can do it ...we can do it by first of all auditing and monitoring by using alarm system , audits and investigation we can detect bad people and have effective control. Alerts or alarms should be designed to identify event or any negative event in the organisation this is achieved by security team when the are continuously monitoring the events happening and finding about insiders abusing the Information technology department of the organisation. Nowadays organisation are using security information and event management and log management tools to augment data collection . We need to do background verification of the workers need to check their addresses, education,character,references ,licence etc.security and awareness an be achieved by introducing training programmes which include awareness on fraud and should include exampls of some insiders being produced and prosecuted.Next is we need maintain code of conduct and confidentiality of agreement by workers. Verification and validation by internal audits by the use of fundamental healthcare fraud management practices . In short stepped up audit , effort technologies and general awareness publicising the offenses are best way to prevent health care fraud in a healthcare facility.