Statistics and Health Care Fraud: How to Save Billions

Statistics and Health Care Fraud: How to Save Billions provides an overview of statistical and analytical methods used in health care fraud audits, using real-world examples to illustrate how fraud analytics can help handle the large size and complexity of these claims. The author, Dr. Tahir Ekin, is a Brandon Dee Roberts Associate Professor of Quantitative Methods in McCoy College of Business, Texas State University, and has extensive experience in health care fraud detection.

Format: Paperback / softback
Length: 142 pages
Publication date: 19 February 2019
Publisher: Taylor & Francis Ltd

Statistics and Health Care Fraud: How to Save Billions is a valuable resource for the public, empowering individuals to become more informed citizens through discussions of real-world health care examples and fraud assessment applications. The author presents statistical and analytical methods used in health care fraud audits without requiring any mathematical background, making it accessible to a wide range of readers. The public suffers from health care overpayments, whether directly as patients or indirectly as taxpayers, and fraud analytics provides valuable tools for handling the large size and complexity of these claims.

The book begins with a brief overview of global healthcare systems, such as the U.S. Medicare system, providing a foundation for the subsequent discussions. It then delves into the topic of medical overpayments and assessment initiatives, using a variety of real-world examples to illustrate the concepts. The book covers key subjects such as:

Description and visualization of medical claims data: This involves analyzing and interpreting large datasets to identify patterns and anomalies that may indicate fraudulent transactions.

Prediction of fraudulent transactions: By leveraging advanced statistical techniques, fraud analytics can help identify potential fraudulent activities before they occur, reducing the risk of financial loss.

Detection of excessive billings: By analyzing billing patterns and comparing them to industry standards, fraud analytics can identify cases of overbilling and unnecessary medical procedures.

Revealing new fraud patterns: Through data analysis, fraud analytics can uncover previously unknown fraud patterns and help organizations develop more effective strategies for preventing and detecting fraud.

Challenges and opportunities with health care fraud analytics: While fraud analytics offers significant benefits, it also presents challenges such as data privacy, complexity, and the need for specialized expertise.

Dr. Tahir Ekin, the Brandon Dee Roberts Associate Professor of Quantitative Methods in McCoy College of Business at Texas State University, is the author of this book. With extensive experience in health care fraud detection as a statistician, Dr. Ekin brings a wealth of knowledge and expertise to the subject. His scholarly work on health care fraud has been published in prestigious academic journals such as International Statistical Review, The American Statistician, and Applied Stochastic Models in Business and Industry. He has received recognition for his contributions, including the Texas State University 2018 Presidential Distinction Award in Scholar Activities and the ASA/NISS y-Bis 2016 Best Paper Awards.

Dr. Ekin has developed and taught courses in business statistics, optimization, data mining, and analytics, and his research has practical applications in various industries. He is also actively involved in professional organizations, serving as Vice President of the International Association for Statistical Computing.

In conclusion, Statistics and Health Care Fraud: How to Save Billions is a comprehensive and accessible guide that empowers individuals to understand and combat health care fraud. By presenting statistical and analytical methods in a user-friendly manner, the book helps readers gain a deeper understanding of the issues and develop the skills necessary to identify and prevent fraud in the healthcare industry. Whether you are a healthcare professional, policymaker, or concerned citizen, this book is a valuable resource for improving the efficiency and integrity of our healthcare system.

Weight: 240g
Dimension: 146 x 223 x 10 (mm)
ISBN-13: 9781138197428