> ## Documentation Index
> Fetch the complete documentation index at: https://docs.officeridge.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Fraud prevention

> Fraud incidents, compliance scoring, staff training, billing monitoring, and audits.

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

## Fraud Incidents

Reported fraud incidents with type, estimated loss, and investigation status.

**Columns:** Reported · Type · Loss · Status

<Warning>
  Suspected fraud has reporting obligations that vary by type and payer. Escalate to your compliance
  officer and administrator rather than investigating alone.
</Warning>

## 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.

## Fraud Training

Employee fraud prevention training records with topics and completion status.

**Columns:** Employee · Topic · Date · Status

<Warning>
  Fraud prevention training is a programme requirement, not optional professional development. Every
  employee needs a completed record. Filter on incomplete status before any audit.
</Warning>

## 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:

| Pattern                                  | Where to check                                              |
| ---------------------------------------- | ----------------------------------------------------------- |
| Billing exceeding authorized units       | [Authorizations](/members/authorizations)                   |
| Visits with repeated geofence failures   | [Time & Attendance](/attendance)                            |
| Services billed without a matching visit | [EVV matching](/billing/evv-matching)                       |
| Staff appearing on exclusion lists       | [Credentials and checks](/employees/credentials-and-checks) |

## Fraud Audits

Fraud-specific audit records with risk ratings and remediation status.

**Columns:** Date · Type · Risk · Status

## Running the programme

<Steps>
  <Step title="Train every employee">
    Record topic, date, and completion. New hires need this during orientation.
  </Step>

  <Step title="Monitor billing on a schedule">
    Record monitoring entries with their risk assessment, whether or not anything is found.
  </Step>

  <Step title="Run compliance checks and record the score">
    Scores over time show whether your controls are improving.
  </Step>

  <Step title="Audit periodically">
    Record type, risk rating, and remediation status.
  </Step>

  <Step title="Investigate and escalate incidents">
    Record any incident with its type and estimated loss.
  </Step>
</Steps>

<Tip>
  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.
</Tip>

## Troubleshooting

| Problem                                 | What to check                                                                  |
| --------------------------------------- | ------------------------------------------------------------------------------ |
| Training records show gaps              | Filter on incomplete status. New hires are the usual gap.                      |
| Monitoring shows high-risk billing      | Check the member's authorization units and the underlying EVV visits.          |
| Compliance scores are not improving     | Scores reflect control effectiveness. Address findings rather than re-scoring. |
| An excluded provider delivered services | Do not bill for them. Escalate immediately — this is a reportable matter.      |

## Related

<CardGroup cols={2}>
  <Card title="Credentials and checks" icon="badge-check" href="/employees/credentials-and-checks">
    Exclusion list screening.
  </Card>

  <Card title="Quality and audits" icon="clipboard-check" href="/compliance/quality">
    Automated findings and disallowances.
  </Card>
</CardGroup>