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Fraud Risk Assessment and Planning Tool Model Healthcare

Name

Fraud Risk Assessment and Planning Tool Model Healthcare

Description

Special Fraud Risk Considerations When Auditing Health Care Organizations Healthcare Providers Financial audit risks relating to healthcare provider organizations typically revolve around recognition of accounts receivables and revenue. In relation to accounts receivable, audit risks include overstatement of receivables due to inadequate assessment/reassessment of the methodology for establishing allowance for uncollectable accounts. In addition to an overall financial statement audit risk, revenue recognition may also be considered as an area for potential fraud as pressure to meet established revenue goals may lead to fraudulent reporting and recording of claims to healthcare payers. Typical schemes of provider revenue fraud include billing for services not provided to patients, falsification of claims (billing codes, dates, patient), incorrect collection of co-pays or deductibles, and improper use of prescription drugs. The magnitude of these risks (both overall audit risks and fraud risks) is assessed during the financial statement risk assessment process, including the brainstorming session during the planning phase of the audit.

Standard (Non-IT) Audit Program

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