BC Advantage - 2025 Issue 6

Fraud Indicators and Red Flags: Part 1 - When Audit Managers Knowingly Skew Audit Results 

Fraud cannot be eliminated. No system is completely fraud-proof, as any system can be bypassed or manipulated. However, it can be detected early by paying greater attention to common fraud indicators. This article follows a road less-traveled by discussing the potential of audit managers knowingly skewing audit results, causing unintended consequences within what appears to be a well-functioning compliance program.   Defining Terms   The Office of Inspector General (OIG) provides compliance guidance documents for healthcare provider use. There are also self-reporting mechanisms in place to report overpayments on the OIG website (Self-Disclosure) and Self-Referral Disclosure for voluntary...

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