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The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self determination.
Obtaining a certificate is voluntary in some fields, but in others, certification from a government-accredited agency may be legally required to perform certain jobs or tasks. Organizations in the United States involved in setting standards for certification include the American National Standards Institute (ANSI) and the Institute for ...
An overpayment scam, also known as a refund scam, is a type of confidence trick designed to prey upon victims' good faith.In the most basic form, an overpayment scam consists of a scammer claiming, falsely, to have sent a victim an excess amount of money.
Learn how to recognize a merchant services scam and prevent payment fraud while protecting your business and customers.
Insurance fraud includes a wide variety of schemes in which insureds attempt to defraud their own insurance carriers, but when the victim is a private individual, the con artist tricks the mark into damaging, for example, the con artist's car, or injuring the con artist, in a manner that the con artist can later exaggerate.
Health care fraud includes "snake oil" marketing, health insurance fraud, drug fraud, and medical fraud. Health insurance fraud occurs when a company or an individual defrauds an insurer or government health care program, such as Medicare (United States) or equivalent State programs. The manner in which this is done varies, and persons engaging ...
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
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