for DR.SAMUELSON only!!!

Week#5-To Do List-SMHS

1. Assigned Readings:

Chapter 21: Operational Finance and Budgeting

Chapter 22: Underwriting and Rating

Chapter 23: Information System and Electronic Data Interchange in Managed Health Care

Chapter 24: Health Plans and Medicare

https://www.youtube.com/watch?v=zE4lumBIWuI

https://www.youtube.com/watch?v=iQrwnEFHTfE

2. Case Analysis:

Research and retrieve a case involving fraudulent activity committed by a provider or patient, then identify:

The act that was committed.

Who committed, and against who?

What regulatory authorities were involved?

Were there any regulatory authorities who were not involved, who you believe should have been?

What actions were taken against the individual? Were they appropriate, based upon the fraudulent activity?

What additional payer and managed care fraud control efforts would you recommend, to prevent such cases?

3. Discussion:

What is the value of Information Systems to a payer? Provide at least one example.