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Towson University *
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NET109
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Information Systems
Date
Dec 6, 2023
Type
docx
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Uploaded by dsean51
It is important to note that within 2023, the Nationwide Health Care Fraud
Enforcement Action had concluded, "criminal charges brought against
telemedicine platform owners, laboratory owners, durable medical
equipment (DME) providers, hospice operators, and pharmacists, among
others, with losses exceeding $1.1 billion." (
2023 Nationwide Health Care
Fraud Enforcement Action
, 2023). In order to better apprehend fraud and
identify it within a timely manner, data analytics can help detection be more
efficient. Alongside laws, the use of third-party audits can assist highly in
recognizing fraud, as well as deterring fraud and reducing the risk within any
entity, including the healthcare community. To assist such auditors the data
analysis systems set in place can help identify all recorded transactions and
create a seemingly easier experience and thorough review.
Data Analytics can help detect fraud by means of flagging any suspicious
activity, as well as, being a means of documentation. Which is important in
all career paths, and business ventures, no matter the field.
Three ways to identify red flags would be:
1.
Stratification of numbers, which can allow identification of
extremely high or low monetary notation
(Fraud Detection
Using Data Analytics in the Healthcare Industry, 2014).
2.
Timing Differences Data Analytics Tests, which can identify times of
input of information, compared to purchases with similar data
ensuring it is all accurate and non-fraudulent (
Anti-Fraud Data
Analytics Tests
, n.d.).
3.
Improper Asset Valuations Data Analytics Tests, which can be used
to "Identify sales of fixed assets significantly before the end of
depreciation lifecycle, Identify surplus or obsolete inventory
....
"
(
Anti-Fraud Data Analytics Tests
, n.d.).
Sources
2023 Nationwide Health Care Fraud Enforcement Action
. (2023, June 28).
Office of Inspector General | Government Oversight | U.S. Department of
Health and Human Services. https://oig.hhs.gov/newsroom/media-
materials/2023-nationwide-health-care-fraud-enforcement-action/
Anti-Fraud Data Analytics Tests
. (n.d.). Www.acfe.com.
https://www.acfe.com/fraud-resources/fraud-risk-tools---coso/anti-fraud-data-
analytics-tests
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