HealthcarefraudisanincreasinglylargeproblemintheUnitedStatesforpatients,taxpayers,andthegovernment,withtheNationalHealthcareAnti-FraudAssociation(NHCAA)estimatingthecoststobemorethantensofbillionseachyear(NHCAA,2018).Toaddressthisissue,governmentagenciesandinsurerscanutilizedataanalyticstodetectandpreventhealthcarefraud.TheAmericanSeniorCommunities(ASC)caseisarecentexampleofacomplexhealthcarefraudschemecommittedbyseveralhighrankingofficersinvolvingkickbacks,fictitiousvendors,andmoneylaunderingthroughshellcompanies.Theindictmentdetailshow$16millionwasstolenisparticularlygiventhepopulationcaredforbyASC—theelderly,individualswithdisabilities,lowincomeadults,pregnantwomenandchildren.Thiscasedemonstratesseveralwayshealthcarefraudcanbeperpetrated,highlightstheroleoftheauditor,andintroducesstudentstotheimportanceofemployingdataanalyticstopreventanddetectfraud.
