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The Most Common Fraud in the Acquisition and Payment Cycle

question 127

Essay

The most common fraud in the acquisition and payment cycle is for the perpetrator to issue payments to fictitious vendors and deposit the cash in fictitious accounts. What procedures could the company take to prevent this type of fraud?


Definitions:

Insurance Payment

Money paid to an insurance company for coverage, which can be in the form of premiums, deductibles, or copayments.

Claim Submitted

The process of requesting payment from an insurance company for healthcare services provided.

Medicare-Approved Amount

The predetermined cost that Medicare determines as reasonable for a medical service or supply, which sets the limit on what Medicare will pay and what you may be billed.

Ambulatory Payment Classification

A system used by Medicare and other health insurance programs to pay for outpatient services on a fixed rate based on the diagnosis and procedure rather than individual services provided.

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