Courses - Antifraud
Fraud, Part I (Introduction)
You’ll gain valuable insight from this broad overview of health insurance fraud. This self-study course focuses on investigative methods for detecting fraud and delves into the many areas in which fraud occurs, including fraud and abuse by providers, consumers, agents, and others.
What You’ll Learn:
- Methods investigators use to uncover and deter fraud perpetrated against the health care and health insurance industries
- How health insurance fraud schemes work
- How to identify fraudulent practices in medical expense insurance, managed care, and disability income insurance
- What legal, regulatory, and compliance issues affect anti-fraud efforts
- Relevant terms, case scenarios, and key concepts
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Who Should take this Course:
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Enrollment
$195 AHIP Members; $240 Non-members
To enroll in a course, or purchase a text book, please log in, and browse our Center’s online catalog. If you are a new user, please register for an account to get started.
Publication
Health Care Fraud: An Introduction to Detection, Investigation, and Prevention
$40 AHIP Members; $50 Non-members
Earn a Designation
This course is good towards earning the following Center designation:
- Health Care Anti-Fraud Associate (HCAFA)
- Health Insurance Associate (HIA®)
- Dental Benefit Associate (DBA)
- Healthcare Customer Service Associate (HCSA)
- Managed Healthcare Professional (MHP)
This course also meets the continuing education requirements of the National Health Care Anti-Fraud Association’s (NHCAA) Accredited Health Care Fraud Investigator (AHFI) designation.
Continuing Education Credits
- The Commission for Case Manager Certification (CCMC) grants 20 contact hours for this course.
Fraud, Part II (Key Products)
This online course examines the impact of fraud on a range of insurance products—disability income, life, long-term care, and dental coverage. You’ll become familiar with federal and state roles in combating fraud, explore the private sector, and get an understanding of legal constraints placed on enforcement efforts.
What You’ll Learn:
- Impact of fraud on a range of insurance products, including disability income, life, long-term care, and dental coverage
- Specialized health care fraud considerations that must be taken into account when dealing with pharmaceutical, supplemental, and Medigap insurance plans
- The roles of federal and state government entities in combating health care fraud
- The role of the private sector in detecting health care fraud and the legal constraints placed upon its enforcement efforts
- Relevant terms, case scenarios, and key concepts
Who Should take this Course:
- Employees of health insurance plans and health care organizations
- Managers and staff working in special investigation units (SIUs)
- Corporate counsel and legal advisors
- Compliance officers
- Claims analysts
- Fraud examiners
- Federal and state regulatory personnel
- Others in related fields who seek more knowledge in fraud investigation
Enrollment
$195 AHIP Members; $240 Non-members
To enroll in a course, or purchase a text book, please log in, and browse our Center’s online catalog. If you are a new user, please register for an account to get started.
Earn a Designation
This course is good towards earning the following Center designation:
This course also meets the continuing education requirements of the National Health Care Anti-Fraud Association’s (NHCAA) Accredited Health Care Fraud Investigator (AHFI) designation.
Fraud, Part III (Legal Issues)
Sharpen your skills in combating fraud with this in-depth self-study course exploring public and private enforcement activities. You’ll learn about tools available to government agencies and get an inside look at the legal issues fraud investigators deal with involving compliance and privacy.
What You’ll Learn:
- The roles of federal and state government in combating health care fraud and the statutes and tools available to these agencies
- Private sector enforcement activity with an emphasis on legal issues such as compliance and privacy
- Legal constraints placed upon enforcement efforts
- How public and private sectors can work together to combat fraud
- Relevant terms, case scenarios, and key concepts
Who Should take this Course:
- Employees of health insurance plans and health care organizations
- Managers and staff working in special investigation units (SIUs)
- Corporate counsel and legal advisors
- Compliance and privacy officers
- Claims analysts
- Fraud examiners
- Federal and state regulatory personnel
- Others in related fields who seek more skills in fraud investigation
Enrollment
$155 AHIP Members; $190 Non-members
To enroll in a course, or purchase a text book, please log in, and browse our Center’s online catalog. If you are a new user, please register for an account to get started.
Publication
Legal Issues in Healthcare Fraud and Abuse: Navigating the Uncertainties
David E. Matyas, Esq. and Carrie Valiant, Esq., $139 AHIP Members; $169 Non-members
Earn a Designation
This course is good towards earning the following Center designation:
This course also meets the continuing education requirements of the National Health Care Anti-Fraud Association’s (NHCAA) Accredited Health Care Fraud Investigator (AHFI) designation.