Table 5.

Articles related to methods for preventing medical fraud and abuse

Methods for preventing medical fraud and misconduct	Study Type	Study Population	Article Title	Country	Year	Author
Hiring committed staff, training leaders to foster a culture of integrity, providing feedback to physicians, increasing peer and colleague oversight, educating patients, conducting basic research to understand factors leading to ethical violations	Evidence-Informed Recommendations	Reports the consensus recommendations of a working group that was convened at the end of 4-year research project funded by the National Institutes of Health	Preventing Egregious Ethical Violations in Medical Practice: Evidence-Informed Recommendations from a Multidisciplinary Working Group [31]	USA	2018	James M. DuBois and et al.
Educating providers and pharmacists on regulations surrounding fraudulent prescriptions, reimbursements, and referrals; empowering patients to identify fraud; encouraging providers to report suspicious cases	Systematic review	Describe the types and trends of Medicare and Medicaid fraud	Recommendations to protect patients and health care practices from Medicare and Medicaid fraud [23]	USA	2003	Zhen Xing Chen and et al.
Increasing federal oversight of fraud and abuse, using data modeling and data mining	Data Modeling and Data Mining	Healthcare Fraud and Abuse	Healthcare fraud and abuse [32]	USA	2009	William J Rudman and et al.
Promoting a culture of ethical behavior, enforcing criminal law	Comparative research, fraud cases and literature study has been proposed	From 17 top suspicions analyzed, we reported eventually 12 of those to offcials,	Outlier based Predictors for Health Insurance Fraud Detection within U.S. Medicaid [16]	USA	2013	Guido van Capelleveen and et al.
Training staff, implementing Computer-Assisted Coding (CAC), increasing federal oversight on fraud and abuse	Data Modeling and Data Mining	Healthcare Fraud and Abuse	Health Care Fraud and Abuse	USA	2002	William J Rudman and et al.
Developing written policies, procedures, and behavior standards; maintaining open communication about compliance, education, and concerns; conducting audits and oversight; enforcing consistent discipline; implementing corrective actions	Systematic review	Prevent fraud ways	Prevent fraud in your medical practice [33]	USA	2016	Ballou-Nelson
Integrating activities to facilitate control, risk management to identify potential fraud, hiring qualified staff, adopting programs to predict and classify potential events before claims are made	Systematic review	Fraud mitigation strategies	What Should Health Care Organizations Do to Reduce Billing Fraud and Abuse? [34]	USA	2020	Katherine Drabiak & Jay Wolfson
Allocating resources to protect against fraud, waste, and abuse; taking firm measures against fraudulent abuse of the system; reducing healthcare costs and improving quality; partnering with the Department of Justice and Health to reduce fraud	BOOK	The Health Insurance Portability and Accountability Act of 1996	The Health Care Fraud and Abuse Program, Health Care Issues, Costs and Access [35]	USA	2013	Lorena Townsend
Revising guidelines, medical protocols, and treatment guidelines; using billing provider identifiers and a registration portal; training auditors; enhancing capacity and awareness in regulatory bodies	Sub-groups efforts and deliberations over a short period of 12 weeks.	health insurance industry	FICCI Working Paper on Health Insurance Fraud [17]	India	2014	Hsrii
New employees should read and sign the company's policies and ethical practices. Writing ethical codes for companies that specifically operate in the healthcare sector Definition of accounting standards specific to the health sector, Definition of the fraud tree specific to the health sector, Writing internal control procedures in health occupations Employing internal auditors who hold a certificate from the Turkish Institute of Internal Auditors Hiring fraud examination specialists who are certified by a reputable fraud association Appointment of audit committee members from outside the organization	Literature review	Health sector in Turkey	Fraud Prevention in Health Sector: Proposals of Solution [36]	Turkey	2018	Kiymet Tunca Caliyurt
Training experts on how to detect fraud in the recruitment of specialized personnel Not turning a blind eye to cheating Raising the cultural level of society and increasing awareness	Machine learning and Data maining and developed framework	Leading insurance companies in Turkey (Company ABC)	An interactive machine-learning-based electronic fraud and abuse detection system in healthcare insurance [37]	Turkey	2016	Ilker Kose and et al.
Supervision of medical centers and insured individuals by legal entities Drafting regulations regarding dealing with cheating and misconduct Simultaneous use of multiple fraud detection methods Drafting the procedure for handling medical documents	Survey	Five electronic commerce systems; which are credit card, telecommunication, healthcare insurance, automobile insurance and online auctio	Fraud detection system: A survey [38]	Malysia	2016	Aisha Abdallah and et al.