Healthcare Fraud Prevention and Detection

Healthcare fraud can have devastating impacts on patient care, financial integrity, and regulatory compliance. This intermediate-level course equips accounting and finance professionals—especially CPAs—with the knowledge and tools needed to proactively prevent, detect, and respond to fraud, waste, and abuse in healthcare organizations.

Through a comprehensive curriculum, learners will explore key fraud schemes affecting providers, payers, and patients, along with enforcement processes and applicable regulations including the False Claims Act, Anti-Kickback Statute, and HIPAA. Real-world case studies illustrate red flags and control failures, while structured frameworks such as COSO and the fraud triangle guide learners through effective risk assessments.

Participants will also gain hands-on insights into data-driven detection methods, including anomaly detection, benchmarking, and predictive modeling, as well as the importance of tone at the top and whistleblower protections.

Whether you're conducting audits, advising on compliance, or managing financial operations in the healthcare sector, this course will help you identify vulnerabilities and implement controls that reduce risk and enhance fraud oversight.