CFE – Financial Transactions and Fraud Schemes — Question 40
To detect health care provider fraud, a fraud examiner should be alert for which of the following red flags?
Answer options
- A. Consistently low percentage of coding outliers present
- B. Unusually low profits compared to similar businesses in the same region
- C. Lack of supporting documentation for claims under review
- D. Details in supporting documentation that match the health care claim
Correct answer: C
Explanation
The correct answer is C because the absence of supporting documentation can indicate fraudulent claims. Options A and B may suggest inefficiencies or competitive issues but are not direct indicators of fraud. Option D is not a red flag, as matching details in documentation is expected for legitimate claims.