CHS 426: Health Care Fraud and Compliance Investigation

This class will look at the devastating effects that healthcare fraud has on the financial resources of the United States. We will review cases of healthcare fraud that involved more than just money - the ultimate price - human lives. As of 2015, the government has collected and returned over $29.4 billion to the Medicare Trust Fund. This does not take into account repayment to the Medicaid fund or other commercial payers. In 2017, the USA has budgeted 28% of the federal budget for healthcare. This amount is highest of all the other categories including defense (21%) and pensions (Social Security 25%.) We will review healthcare fraudulent schemes and methods to detect these schemes. Who are the perpetrators? Who are the victims? Methods of investigation will be explored to look at how to prevent fraud with current laws, task forces and compliance efforts. Whistleblowers will be discussed regarding their efforts to stop healthcare fraud and the risks they took to come forward. The class will also examine the many free resources available to the public on the topic of healthcare fraud. Students will have a chance to investigate possible career paths related to fighting healthcare fraud.

Course Credits