Index
0–9
340 B program abuse
definition
340 B drugs
A
Abnormal
financial errors
patient
payer
provider
vendor/supplier
Abuse
definition
Accounts Receivable Pipeline
definition
employee/plan sponsor
patient
payer
provider
vendor/supplier
Administrative Simplification Compliance Act (ASCA)
Adulterated drugs, see counterfeit drugs
The Affordable Care Act
Ambulatory patient group (APG) codes
Anomalies
Anomaly continuum
Antisocial personality disorder (APD)
Association of Certified Fraud Examiners (ACFE)
Audit clauses
Auditing Program Integrity
Auditor's checklist
capitation-structured model
central checklist illustration
communication activity
employer/plan sponsor
government plan sponsor
government plan sponsor
operational activity
operational flow activity (OFA)
patient
payer
prospective model
provider
rule-based activity
TPA’s
vendor/supplier
Auto-adjudicated claims
B
Bad drugs
Bad faith
Behavior pipelines
Benchmark
Beneficiary fraud, see recipient fraud
Benefit program
Blue Cross
C
Case history, see example case study
Center on Medical Record Rights and Privacy
Centers for Medicare and Medicaid Services (CMS)-1500
case study
copy
definition
fields
Client, see patient
Compliance guidance publication
Consequence Healthcare Continuum (C-HCC)
case study
definition
illustration
Consumer, see patient
Consumer Bill of Rights
Consumer Market Activity (CMA)
CHECK FOR CONTINUITY continuum audit model
description and purpose
Corporate integrity agreement (CIA)
definition
Cost shifting ...
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