Date of Conferral
2022
Degree
Doctor of Business Administration (D.B.A.)
School
Management
Advisor
Warren Lesser
Abstract
Fraudulent business activities have the potential for adverse business outcomes. Speech pathology business owners who lack a robust fraud prevention strategy may subject their practices to severe civil and criminal penalties. Grounded in Wilhelm’s eight-stage fraud management lifecycle theory, the purpose of this qualitative multiple case study was to explore strategies speech pathologist business owners used to prevent Medicare claims fraud. The participants were five speech pathologist business owners from three practices in a western U.S. state who successfully implemented fraud prevention strategies. Data were collected using semistructured interviews and reviewing organization policies and procedures manuals. Three themes emerged using Yin’s five-step data analysis process: ethics policies, fraud prevention training, and techniques. One key recommendation is for speech pathologist business owners to ensure billing codes are cross-referenced with therapy notes to ensure the correct billing codes match the services rendered. The implications for positive social change include the potential to increase access to needed care for the Medicare population and reduce potential physical harm to patients.
Recommended Citation
Densmore, Joseph, "Strategies to Prevent Medicare Claims Fraud Committed by Speech Pathologists" (2022). Walden Dissertations and Doctoral Studies. 13307.
https://scholarworks.waldenu.edu/dissertations/13307
