Overview
Health insurance fraud continues to present significant financial, operational, and reputational challenges for insurers, healthcare providers, regulators, employers, and consumers. As healthcare systems become increasingly complex, organisations must strengthen their ability to identify fraudulent activities, detect emerging fraud schemes, conduct effective investigations, and implement robust anti-fraud controls.
This programme provides a comprehensive introduction to health insurance fraud and explores fraud risks across healthcare providers, consumers, agents, brokers, insurer employees, managed care arrangements, disability insurance, dental benefits, and prescription drug programmes. Participants will also examine fraud detection techniques, investigative processes, anti-fraud technologies, evidence gathering, surveillance, reporting, and collaborative anti-fraud initiatives.
Download BrochureLearning Outcomes
Upon successful completion of this programme, you will be able to:
- Explain the nature, impact, and types of fraud affecting health insurance and healthcare systems;
- Identify common fraud schemes involving healthcare providers, consumers, agents, brokers, and insurer employees;
- Recognise fraud indicators and red flags across health insurance, managed care, disability, dental, and prescription drug programmes;
- Apply fraud detection techniques, investigative methods, and anti-fraud technologies used within health insurance operations;
- Explain the processes involved in fraud investigations, including interviews, surveillance, evidence management, and reporting;
- Understand the legal, regulatory, compliance, and organisational considerations that influence anti-fraud activities; and
- Evaluate the role of anti-fraud programmes, inter-agency collaboration, and stakeholder cooperation in combating health insurance fraud.
