Course purpose
This course introduces forensic-accounting work in hospitals, clinics, pharmacies, laboratories, insurers and publicly funded health programmes. It shows how to map care delivery, clinical documentation, coding, claims, authorization, procurement, medicines, payroll and payment records into an evidence-led financial review. Learners test duplicate or unsupported claims, identity misuse, upcoding indicators, unbundling, phantom services, conflicts, procurement abuse, inventory diversion and falsified-product risk without treating an anomaly as proof of fraud. The course emphasizes patient safety, confidentiality, continuity of care, data provenance and fair provider review. It does not authorize the learner to determine medical necessity, diagnose a patient, interpret clinical standards, make legal findings or restrict care without the responsible clinical, legal, compliance and regulatory specialists.
Learning outcomes
By the end of this course, you should be able to:
1. Map a healthcare service, patient episode, provider, payer, claim, inventory flow and accounting entry into a controlled evidence model.
2. Test healthcare claims, identities, documentation, coding, procurement and medicines data for supported exceptions and financial effects.
3. Report proportionate findings, limitations and remediation while protecting patients, privacy, due process and continuity of care.
Forensic CPD
