Overview
Healthcare fraud is a major challenge affecting health insurance systems, healthcare providers, and patients. Fraudulent practices such as false billing, exaggerated medical claims, unnecessary medical procedures, and identity misuse can lead to significant financial losses and undermine the integrity of healthcare financing systems.
This course provides a practical introduction to the nature of healthcare fraud and the measures used to detect, investigate, and prevent fraudulent activities within healthcare and health insurance environments. Participants will develop an understanding of common healthcare fraud schemes, the indicators that may signal fraudulent behaviour, and the role of professionals in safeguarding healthcare systems.
The programme also highlights the importance of effective monitoring, internal controls, and collaboration between insurers, healthcare providers, and regulators in strengthening healthcare fraud prevention efforts.
Who Should Enrol
This course is designed for professionals involved in healthcare financing, health insurance operations, and fraud prevention, including:
- Health insurance claims officers and administrators
- Fraud investigators and compliance officers
- Insurance underwriters handling health insurance policies
- Healthcare administrators and provider network managers
- Insurance agents and intermediaries involved in health insurance distribution
- Professionals seeking to strengthen their understanding of healthcare fraud risk
What You Will Learn
Participants will gain practical knowledge and understanding of:
- The nature and impact of healthcare fraud on healthcare systems
- Common healthcare fraud schemes and fraudulent billing practices
- Warning signs and indicators of healthcare fraud
- Investigation techniques used in healthcare fraud detection
- Internal control measures used to prevent fraudulent activities
- Best practices for strengthening healthcare fraud prevention
Learning Pathway
This course forms part of the IIEA E-Academy Learning Pathway Framework™ for Advanced Insurance Professionals, designed to strengthen technical expertise across key areas of insurance practice.
Certification
Participants who successfully complete the course requirements will receive a Certificate of Achievement recognising their successful completion of the programme.
This course complements other fraud and risk management programmes such as:
- Health Insurance Fraud Fundamentals
- Insurance Fraud Prevention Fundamentals
- Insurance Fraud Essentials
and helps build strong capability in detecting and preventing fraud within healthcare and health insurance systems.
Learning Outcomes
On completion of this course, you''ll be able to:
- Understand the types of health care systems;
- Understand the different types of of health care fraud schemes;
- Compare the different ways fraud schemes work and where they often occur;
- Know the various types of healthcare red flags and how to identify the,and
- Understand how to identify fraudulent practice.
