Learning Objectives
In this section, the student will:
- Define fraud and abuse/denials
- Describe how to appeal denied claims
- Recognize the scope of fraud and abuse
- Identify which agencies are involved in fraud and abuse/denials utilization and investigations
Resources
- What is Health Care Fraud and Abuse?; Health Net Federal Services
- FBI -> What We Investigate ->White-Collar Crime -> Health Care Fraud.
- Denial of Claim; from Healthinsurance.org
- How to Appeal a Health Insurance Denial; from Office of the Insurance Commissioner of WA State
- How to Appeal an Insurance Company Decision; from Healthcare.gov