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These five tabs make up your fraud, waste, and abuse prevention programme.

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Fraud Incidents

Reported fraud incidents with type, estimated loss, and investigation status. Columns: Reported · Type · Loss · Status
Suspected fraud has reporting obligations that vary by type and payer. Escalate to your compliance officer and administrator rather than investigating alone.

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Fraud Compliance

Fraud compliance checks with scoring and risk-level assessments. Columns: Check Date · Score · Risk Regular checks with a recorded score are what demonstrate an active programme. A single check a year does not.

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Fraud Training

Employee fraud prevention training records with topics and completion status. Columns: Employee · Topic · Date · Status
Fraud prevention training is a programme requirement, not optional professional development. Every employee needs a completed record. Filter on incomplete status before any audit.

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Fraud Monitoring

Fraud monitoring entries with billing amounts and risk-level flags. Columns: Service Start · Billing · Risk This is where billing patterns get examined. Entries flagged at higher risk warrant review against the underlying visits and authorizations. Common patterns worth monitoring:

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Fraud Audits

Fraud-specific audit records with risk ratings and remediation status. Columns: Date · Type · Risk · Status

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Running the programme

1

Train every employee

Record topic, date, and completion. New hires need this during orientation.
2

Monitor billing on a schedule

Record monitoring entries with their risk assessment, whether or not anything is found.
3

Run compliance checks and record the score

Scores over time show whether your controls are improving.
4

Audit periodically

Record type, risk rating, and remediation status.
5

Investigate and escalate incidents

Record any incident with its type and estimated loss.
The value of this module is the record of routine activity, not the incidents. Monitoring entries showing nothing untoward are exactly what demonstrates a working programme.

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Troubleshooting

Credentials and checks

Exclusion list screening.

Quality and audits

Automated findings and disallowances.