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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 ...
Jimmy Carter signs Medicare-Medicaid Anti-Fraud and Abuse Amendments into law. The Office of Inspector General for the U.S. Department of Health and Human Services, as mandated by Public Law 95-452 (as amended), is established to protect the integrity of Department of Health and Human Services (HHS) programs, to include Medicare and Medicaid programs, as well as the health and welfare of the ...
"Unbundling" means the "process of breaking apart something into smaller parts". [5] In the context of mergers and acquisitions, unbundling refers to the "process by which a large company with several different lines of business retains one or more core businesses and sells off the remaining assets, product/service lines, divisions or subsidiaries."
Fraud detection is a knowledge-intensive activity. The main AI techniques used for fraud detection include: Data mining to classify, cluster, and segment the data and automatically find associations and rules in the data that may signify interesting patterns, including those related to fraud.
It has in the past included in its mission the goal of preventing "fraud, deception, and unfair business practices in the marketplace". [6] It does so by "collecting reports from consumers and conducting investigations, suing companies and people that break the law, developing rules to maintain a fair marketplace, and educating consumers and ...
Insurance fraud can be classified as either hard fraud or soft fraud. [14] Hard fraud occurs when someone deliberately plans or invents a loss, such as a collision, auto theft, or fire that is covered by their insurance policy [15] in order to claim payment for damages. Criminal rings are sometimes involved in hard fraud schemes that can steal ...
The California mom who pleaded guilty to running an organized retail crime ring that stole millions of dollars in beauty products from Ulta Beauty and Sephora to resell on Amazon will now have to ...
Bundling is the setting of the total price of a purchase of several products or services from one seller at a lower level than the sum of the prices of the products or services purchased separately from several sellers.