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Fraud Detection Using Data Analytics in the …

DISCUSSION WHITEPAPER Fraud Detection Using data Analytics in the Healthcare Industry2 DISCUSSION PAPERT able of ContentsWHAT IS Fraud ? ..3 WHO IS RESPONSIBLE FOR Fraud Detection ? ..3 WHY USE data ANALYSIS FOR Fraud Detection ? ..4 ANALYTICAL TECHNIQUES FOR Fraud Detection ..5 Fraud Detection PROGRAM STRATEGIES ..5 TIME AND ATTENDANCE ANALYSIS UNCOVERS Fraud ..6 HEALTHCARE ..6 HEALTHCARE RELATED Fraud SCHEMES ..6 OTHER RESOURCES ..7 ABOUT ACL ..83 DISCUSSION PAPERWhat is Fraud ? Fraud encompasses a wide range of illicit practices and illegal acts involving intentional deception or misrepresentation. The Institute of Internal Auditors International Professional Practices Framework (IPPF) defines Fraud as: .. any illegal act characterized by deceit, concealment, or violation of trust. These acts are not dependent upon the threat of violence or physical force. Frauds are perpetrated by parties and organizations to obtain money, property, or services; to avoid payment or loss of services; or to secure personal or business advantage.

3 ISCSSIN PAPER What is Fraud? Fraud encompasses a wide range of illicit practices and illegal acts involving intentional deception or misrepresentation.

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