Imagine that a hospital in the United States has recruited a billing specialist who reports to the manager of the billing department. The responsibility of the billing specialist is to ensure compliance with billing policies and procedures. The manager has begun an audit of the department’s adherence to policies and procedures. The audit reveals that the recently recruited billing specialist is not following the standard billing guidelines. In several patient bills, the manager observes billing errors and noncompliance with the hospital’s standard process. After investigation, the manager determines that it is fraudulent billing.
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