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The government has a series of agencies, policies, and regulations that help prevent fraud in the health care sector. However, because there are always new types of fraud popping up, it’s important to stay up to date on fraud trends and ways your organization can avoid similar issues. In this assessment, you’ll analyze a case of health care fraud to determine how it occurred, what the outcome was, and how this type of fraud might be prevented in the future. In preparation for this assessment, review the Video Series: HEAT Provider Compliance Training from the Office of Inspector General (OIG) to learn about how compliance trainings can help you avoid fraud issues. Visit the Enforcement Actions page from the Office of Inspector General (OIG) website and select 1 of the articles on a case of health care fraud as your focus for this assessment. Write an analysis of the case selected. Address the following in the analysis: Summarize the incident and the specific fraud that took place. Identify what laws were broken and which regulatory bodies are responsible for oversight of the regulations that were violated. Describe how information is documented throughout the investigation (e.g. within the regulatory bodies). Explain the outcome of the case. If a judgment has not yet been passed, what do you think the outcome of the judgment should be? Justify your response. Describe the communication strategy for informing the public of the fraud. Recommend policy enforcement and communication strategies that would help mitigate cases of this type of fraud in the future.

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