Fraud Investigation, Gottschalk

• Questions to ask whistleblowers, complainants, employers, employees, and healthcare providers who are suspects
• Tips on investigative case planning, goals, and strategies
• Sample visual aids for use when briefing others about your investigative findings
• Guidance on presenting information obtained from healthcare investigations and on how to testify in court
• Techniques for uncovering previously undetected fraud

The book includes a sample case study that walks readers through a mock case--from the time the case is received through the end. The case study demonstrates how to initiate, plan, and conduct a thorough and complete healthcare fraud investigation while incorporating Piper's proven methodology.
Sharing insights gained through Charles Piper's decades of experience as a federal special agent and certified fraud examiner, the Healthcare Fraud Investigation Guidebook aims to revolutionize the way that healthcare fraud investigations are conducted. It provides the understanding you need to not only put a bandage on the problem of healthcare fraud, but to actually start curing the greed that is poisoning the healthcare industry.

Contract and procurement fraud, collusion, and corruption are worldwide problems. Such wrongdoing causes federal, state, and local governments, as well as private-sector corporations and businesses, to lose funds and profits, while the wrongdoers unjustly benefit. Bid riggers conspire to eliminate fair and open competition and unjustly increase prices, allowing some to monopolize industries. Too often, contracting officials and others responsible for placing orders or awarding contracts compromise their integrity and eliminate fair and open competition to favor vendors offering bribes or gifts. This results in unfair playing fields for vendors and causes financial losses for businesses, government agencies, and taxpayers.

Charles Piper's Contract and Procurement Fraud and Corruption Investigation Guidebook educates readers on fraud and corruption schemes that occur before, during, and after contracts are awarded. This book teaches not only how to identify such wrongdoing, but also how to investigate it and prevent reoccurrence. Piper shares the Piper Method of Conducting Thorough and Complete Investigations, his innovative and proven method of investigating contract and procurement fraud, and demonstrates its principles with personal, on-the-job examples (which he calls "war stories") woven throughout the text. Intended for criminal justice students, as well as investigators, auditors, examiners, business owners, policy-makers, and other professionals potentially affected by fraud, this book is a must-read guide to effective procurement and contract fraud investigations from inception to testimony.

It evaluates a number of internal investigation reports to reflect on the practice of fraud examinations. Empirical studies provide a basis to reflect theoretically on practice improvements for fraud examiners. Rather than presenting normative recommendations based on ideal or stereotype situations so often found in existing books, this book develops guidelines based on empirical study of current practice.

Internal investigations should uncover the truth about misconduct or crime without damaging the reputation of innocent employees. Typical elements of an inquiry include collection and examination of written and recorded evidence, interviews with suspects and witnesses, data in computer systems, and network forensics. Internal inquiries may take many forms, depending upon the nature of the conduct at issue and the scope of the investigation. There should be recognition at the outset of any investigation that certain materials prepared during the course of the investigation may eventually be subject to disclosure to law enforcement authorities or other third parties. The entire investigation should be conducted with an eye towards preparing a final report.

As evidenced in this book, private fraud examiners take on complicated roles in private internal investigations and often fail in their struggle to reconstruct the past in objective ways characterized by integrity and accountability.