Analysis Healthcare Fraud Assignment Help: How to Answer This Question

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Original Question

ent: Analysis of Healthcare Fraud and Abuse Objective: To analyze healthcare fraud and abuse with a focus on upcoding, using provided resources to understand trends and implications in specific locations. 2026 CAHIIM Competencies/Performance indicators for this assignment: 3.3.1 Differentiate between healthcare fraud and abuse as defined in legislation. (knows) 3.3.2 Identify the reporting requirements associated with healthcare fraud and abuse. (knows) 3.3.4 Analyze data to identify trends and patterns of intentional or unintentional financial abuse and fraud. (does) 3.3.5 Create reports that justify concerns and allegations of intentional or unintentional healthcare fraud and abuse. (does) Instructions: 1. Review Fraud and Abuse Information: In Week 2, you went through the CMS Fraud and Abuse tutorial. To refresh your understanding, please review the information available in the CMS Fraud and Abuse Overview. 2. Read the Fact Sheet on Laws Against Healthcare Fraud: Access the fact sheet detailing the laws against healthcare fraud here: Overview of Laws Against Healthcare Fraud. 3. Research Upcoding Fraud: Navigate to the following link to find documentation on upcoding fraud: Fraud in Healthcare. o Focus on data from the last five years. o Select information specifically from California (State), and Kentucky (Eastern and Western Districts). o Types of services to explore include: Ambulance/Medical Transport, Home Health, Hospice, and Pharmacy. 4. Analyze the Data: Access the results page for upcoding fraud: Upcoding Fraud Results. o Select “upcoding” from the allegations. o Click on each settlement to find additional information regarding the allegations and settlements related to upcoding. o Now review other allegation types of fraud and abuse. 5. Report: In your report, include the following components: o Difference between fraud and abuse. o Reporting requirements for fraud and abuse. o Data Summary: Describe the type of data available on the website regarding fraud and abuse. o Trends and Patterns: Identify any trends and patterns of fraud and abuse noted from the data. o Concerns and Allegations: Discuss the types of concerns and allegations. o Justification: Explain why these concerns and allegations are justified based on your analysis. o Include citations for any external resources used. Submission: Please submit your report via Blackboard Rubric for Analysis of Healthcare Fraud and Abuse Assignment

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