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Indicators Of Fraudulent Foreign Health Insurance Claims: The Workbook for Field Investigators

WORKBOOK

 

Indicators Of Fraudulent Foreign Health Insurance

Claims: The Workbook for Field Investigators

 

COURSE CONTENT

 

Course 1: CLHI200 – Insurance and Biology

 

Principles and Practice of Insurance

Types of Health Insurance

Human Anatomy and Physiology

Medical specializations and specialists

 

Course 2: CHFI300 – Examining health insurance claims

 

Policies’ Terms and Conditions

Claim Forms and Authorization

Two major types of hospital structure

The unorthodox medical practices

Are hospitals and paramedical centers registered?

Is the alleged attending physician a registered and

licensed medical practitioner?

Reviewing medical and treatment records

Police documents (Extract, FIR, Abstract, and Report)

 

Course 3: CHFI400 – Investigating health/medical expenses

                                    claims

 

Appreciation of French and Spanish for English language speakers

Understanding medical terms and specializations

Writing letters for the various parties: The Ministry, Medical Council,

and Providers

Finding out if a provider is registered and licensed

Finding out that the provider does not physically exist

When the claimant has forged documents of an existing provider

Interviewing the conniving physician-provider

Examining the patients’ and admission/discharge register

Noting the facility’s medical equipment and contents- the art

Taking photographs of the facility’s contents and provider

Obtaining written statement from the physician-provider

Conducting investigations at an independent pharmacy

Conducting investigations at an independent laboratory

Conducting investigations at an independent radiological center

What constitutes catering charges in medical bills?

The Investigator as a Document Examiner

Utilizing the services of a Medical Consultant

 

Course 4: CHFI450 – Dental Insurance

 

The Claim Form

Investigating dental claims

 

Course 5: CHFI500 – LESSONS TOWARDS FULL

                                    CERTIFICATION

 

Report Writing

Ethics of Professional Practice

Instructing and working with the professional – The benefits of working

as a Certified Health Insurance Fraud Investigator (CHFI) or Certified

Health Insurance Anti-Fraud Consultant (CHAC) or Certified Life and

Health Insurance Fraud Investigator (CLHFI) or Certified Life and

 

Health Insurance Anti-Fraud Consultant (CLHAC)