Healthcare fraud can lead to complex litigation, as healthcare insurance is a multifaceted industry. In fact, healthcare fraud expert witnesses often have unique backgrounds in various fields, such as healthcare management, pharmaceuticals, accounting, insurance and finance, health law, and/or economics, as well as the medical and dental fields.
Whether committed by an individual or a medical office, healthcare fraud is a serious crime involving large sums of money. In order to protect healthcare insurers against such perpetrators, insurance companies and hospital administrations implement certain rules and regulations regarding healthcare payment and insurance. Healthcare fraud expert witnesses are knowledgeable in hospital operations in relation to insurance procedures. HMO contracting, Medicare, and provider-based physician contracting are examples of the types of insurance that is vulnerable to healthcare fraud. Pricing strategies regarding pharmacy operations must also be protected against such acts, as prescriptions may be the subject of fraudulent crimes. Healthcare fraud can happen at state, federal, or local levels, so it is important to retain a healthcare fraud expert witness with the right background.
Fraud detection, fraud compliance, risk assessment, risk analysis, quality monitoring, and strategic plans are all implemented as a means of protection against healthcare fraud. Health information management and regulatory procedures are often very relevant in healthcare fraud-related lawsuits.
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