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Introduction to Dental FraudA Comprehensive Guide to Investigating False ClaimsThis is the only training textbook of its kind on how to identify, investigate, report & prosecute cases of suspected dental fraud. Defend against false & fraudulent claims by setting up an effective, proactive anti-fraud program. Introduction to Dental Fraud, published by the California Investigative Academy, provides field proven techniques for identifying, investigating, prosecuting and defending against dental fraud. This text provides a detailed, in-depth, and comprehensive approach to what is unquestionably the most powerful tool in the fight against insurance fraud - the investigative medical audit. View the table of contents to get an idea of the topics covered in this cutting edge training tool. Written by Eric Tackett |
Chapter One -- What is Fraud?
The Criminal Statutes
The Civil Statutes
False Claims vs. Fraudulent Claims
Other Dental Related Healthcare Crimes
The Cost of Fraud
Chapter Two -- The Nature of Dental
Fraud
Who Commits Dental Fraud?
Dental Fraud Schemes
Red Flags: Identifying Dental Fraud
What is a "Red Flag"
Identifying Red Flags
Chapter Three – Referring/Reporting
Requirements
Referring/Reporting Requirements
What Should Be Referred and What Should Not
To Whom Should Suspected Fraud Be Reported?
Sources of Referrals
Appropriate Forms of Reporting Fraud
Chapter Four – Investigating Dental
Fraud
The Investigative Process
Preliminary Evaluations
Interviewing & Statement Taking
Provider Investigations
Collecting & Preserving Evidence
Chapter Five – Defending Against Dental
Fraud
Establishing an Effective Anti-Fraud Program
Acquiring the Tools of an Effective Program
The Federal False Claims Act
The California False Claims Act
Chapter Six – The Process of
Prosecution
Referring Cases for Criminal Prosecution
The "Documented SFC" Package