Payment Integrity Solutions
You’re under pressure. Every month, your organisation leaks millions in improper, fraudulent, or duplicative payments. Audits reveal gaps. Compliance teams raise red flags. Leadership demands accountability. And you’re the one expected to fix it - without clear frameworks, scalable tools, or enterprise-grade methodology. Worse, you may feel like you're reacting instead of leading. Manual reviews, disjointed systems, and outdated recovery processes aren’t sustainable. The cost of inaction? Reputational damage, regulatory scrutiny, and lost trust from stakeholders who expect rigorous financial governance. But what if you could systematically eliminate payment leakage before it happens? What if you had a battle-tested framework to detect, prevent, and recover improper payments - one trusted by top healthcare providers, government agencies, and Fortune 500 finance teams? The Payment Integrity Solutions course gives you exactly that. In just 30 days, you’ll go from overwhelmed and reactive to being the go-to expert with a fully developed, board-ready payment integrity plan - complete with detection protocols, recovery workflows, and executive dashboards that show measurable ROI. One recent learner, Sarah Lin, Senior Audit Manager at a national health payer, used this course to redesign her team’s claims validation process. Within eight weeks, they identified $4.2M in recoverable overpayments and reduced future leakage by 67%. She was promoted two months later. Here’s how this course is structured to help you get there.Course Format & Delivery Details Self-Paced, On-Demand, Immediate Access
The Payment Integrity Solutions course is fully self-paced, with instant online access. You begin the moment you enroll. No fixed start dates. No rigid schedules. You control your learning journey - whether you’re studying late at night or fitting modules between meetings. Most learners complete the core curriculum in 25–30 hours, with tangible results visible within the first two weeks. You’ll be applying frameworks to real organisational challenges from Day 1. Lifetime Access, Future-Proof Learning
Once enrolled, you receive lifetime access to all course materials. This includes every update, revision, and enhancement made over time - at no additional cost. Payment regulations evolve, systems change, and fraud tactics shift. Your training must keep pace. You’ll always have access to the most current methodologies, tools, and templates, ensuring your skills remain cutting-edge and compliant across jurisdictions and industries. Available Anywhere, On Any Device
Designed for modern professionals, the course is mobile-friendly and accessible 24/7 from any internet-connected device. Whether you’re reviewing detection workflows on your tablet during transit or refining recovery strategies from your laptop at home, your progress syncs seamlessly across platforms. Expert Guidance with Direct Support
You’re not learning in isolation. Throughout the course, you have direct access to our team of certified payment integrity consultants. Submit questions, request feedback on your risk assessments, or clarify complex policy interpretations - and receive timely, role-specific guidance. This support ensures you’re always applying concepts correctly, avoiding common implementation pitfalls, and building confidence with every module. Certificate of Completion Issued by The Art of Service
Upon finishing the course, you’ll earn a professionally recognised Certificate of Completion issued by The Art of Service - a globally trusted name in operational excellence, compliance, and risk management training. This certificate validates your mastery of payment integrity frameworks and enhances your professional credibility. It is shareable on LinkedIn, included in resumes, and respected by auditors, regulators, and executive leadership teams worldwide. Transparent Pricing, No Hidden Fees
The course fee includes everything. No surprise charges. No premium tiers. No upsells. What you see is what you get - full access, lifetime updates, expert support, and certification at a single, straightforward price. Accepted Payment Methods
We accept all major payment methods, including Visa, Mastercard, and PayPal - processed securely through encrypted gateways to protect your financial information. Enrollment & Access Process
After enrollment, you’ll receive a confirmation email. Your course access details will be sent separately once your learning account is fully provisioned. This ensures system stability and a smooth onboarding experience for all learners. Risk-Free Learning: 60-Day Satisfied-or-Refunded Guarantee
We stand behind the value of this course with a full 60-day money-back guarantee. If you complete the first four modules and don’t feel significantly more confident in designing, auditing, or managing a payment integrity program, simply request a refund - no questions asked. This is not just a promise. It’s risk reversal. Your confidence comes first. Will This Work For Me?
Yes - even if you’re new to payment auditing, work in a heavily regulated environment, or lack dedicated analytics tools. The frameworks are designed to scale from small operations to enterprise systems. This works even if your organisation uses legacy claims software, has limited data integration, or has previously failed at launching a payment integrity initiative. The course provides phased implementation guides, low-tech workarounds, and stakeholder engagement blueprints that make adoption possible in any setting. With real templates, audit-ready documentation, and regulatory alignment baked into every lesson, you’ll have the tools to succeed - regardless of your current infrastructure.
Module 1: Foundations of Payment Integrity - Definition and scope of payment integrity in modern organisations
- Evolution of improper payments across healthcare, government, and corporate sectors
- Core principles: prevention, detection, recovery, and deterrence
- Understanding the payment lifecycle from initiation to settlement
- Key stakeholders in payment integrity: finance, compliance, audit, legal, and IT
- Differentiating fraud, waste, abuse, and administrative error
- Global regulatory landscape and mandatory reporting requirements
- Impact of improper payments on financial performance and reputation
- Fundamentals of internal controls within payment systems
- Role of governance frameworks in sustaining integrity programs
Module 2: Risk Assessment and Vulnerability Mapping - Conducting a comprehensive payment risk assessment
- Identifying high-risk transaction types and vendor categories
- Mapping vulnerabilities across procurement, claims, payroll, and grants
- Using risk scoring models to prioritise intervention areas
- Data-driven identification of anomaly patterns
- Common red flags in vendor billing behaviours
- Benchmarking against industry-specific leakage rates
- Assessing third-party vendor exposure and contract compliance
- Internal threat vectors: employee collusion and process bypasses
- Documenting findings in a formal risk register
Module 3: Detection Methodologies and Analytical Techniques - Overview of active vs. passive detection strategies
- Rule-based logic for identifying duplicate payments
- Algorithmic detection of overbilling and upcoding
- Statistical outlier analysis for identifying unusual claims
- Time-series analysis to detect recurring improper patterns
- Network analysis for uncovering vendor collusion rings
- Benford’s Law application in payment data validation
- Threshold monitoring and exception reporting systems
- Automated alert configuration and escalation workflows
- Integrating detection logic into existing ERP platforms
Module 4: Data Management and System Integration - Essential data fields for payment integrity analysis
- Standardising data formats across disparate sources
- Building a centralised payment integrity data repository
- ETL processes for extracting, transforming, and loading financial data
- Ensuring data accuracy, completeness, and timeliness
- Data governance policies for maintaining integrity standards
- API integration with core financial and claims systems
- Secure data handling and compliance with privacy regulations
- Using data dictionaries and metadata management
- Creating repeatable data pipelines for ongoing monitoring
Module 5: Policy Development and Compliance Alignment - Drafting a corporate payment integrity policy statement
- Aligning with HIPAA, False Claims Act, and OMB guidance
- Establishing mandatory review procedures for high-dollar payments
- Setting clear roles and responsibilities for oversight
- Developing escalation pathways for suspected misconduct
- Creating standard operating procedures for investigations
- Incorporating whistleblower protections and reporting mechanisms
- Ensuring alignment with SOX, GDPR, and other compliance regimes
- Documentation standards for audit readiness
- Maintaining policy version control and review cycles
Module 6: Fraud Prevention Frameworks and Controls - Pre-payment vs. post-payment control strategies
- Vendor credential checks and real-time validation
- Implementing mandatory supporting documentation requirements
- Designing dual approval workflows for high-risk transactions
- Using automated holds and payment suspensions
- Restricting access based on segregation of duties
- Preventing shell company infiltration through KYC protocols
- Embedding fraud awareness into procurement training
- Monitoring for duplicate tax IDs and bank accounts
- Using predictive analytics to flag high-risk payments pre-release
Module 7: Recovery Operations and Reconciliation - Developing a structured overpayment recovery protocol
- Calculating recovery amounts including interest and penalties
- Drafting demand letters and repayment agreements
- Negotiating settlements with vendors and providers
- Tracking recoveries in a central case management system
- Reconciliation of recovered funds into general ledger
- Reporting recovery metrics to executive leadership
- Establishing time limits for recovery actions
- Handling disputes and appeals from vendors
- Documenting closure of recovery cases for audit trails
Module 8: Technology Platforms and Tool Selection - Evaluating payment integrity software vendors
- Key features to look for in detection and recovery platforms
- Cost-benefit analysis of in-house vs. outsourced solutions
- Integration capabilities with existing financial systems
- Cloud-based vs. on-premise deployment trade-offs
- Vendor due diligence and security certification checks
- Proof-of-concept testing and pilot program design
- Change management strategies for system adoption
- User access controls and role-based permissions
- Troubleshooting common integration errors
Module 9: Team Structure and Operational Models - Designing an internal payment integrity team
- Determining staffing levels based on transaction volume
- Hiring profiles: auditors, analysts, investigators, and managers
- Outsourcing vs. insourcing decision framework
- Hybrid models combining internal oversight and external partners
- Defining KPIs for team performance measurement
- Creating shift schedules for 24/7 monitoring environments
- Establishing interdepartmental communication channels
- Developing escalation trees for urgent findings
- Training plans for new team members
Module 10: Audit and Quality Assurance Protocols - Conducting random payment audits to test control effectiveness
- Sampling methodologies for statistically valid results
- Creating an annual audit plan aligned with risk rankings
- Peer review processes for detection findings
- Quality scoring for investigation reports
- Back-testing detection rules for accuracy and precision
- Measuring false positive and false negative rates
- Corrective action planning for audit deficiencies
- Maintaining audit trail documentation
- Preparing for external regulatory examinations
Module 11: Stakeholder Communication and Executive Reporting - Designing board-level dashboards for payment integrity
- Translating technical findings into business impact
- Monthly reporting templates for CFOs and compliance officers
- Presenting ROI of recovery and prevention efforts
- Storytelling with data to gain leadership buy-in
- Communicating program success across departments
- Drafting press statements for public sector disclosures
- Managing media inquiries about payment errors
- Building trust through transparency and accountability
- Creating shareable summaries for non-technical audiences
Module 12: Legal and Investigative Procedures - When to escalate from error to suspected fraud
- Working with internal legal and compliance counsel
- Preserving evidence for potential litigation
- Conducting interviews with vendors and employees
- Chain of custody protocols for digital records
- Referring cases to law enforcement or regulators
- Coordinating with OIG, DOJ, and state agencies
- Responding to subpoenas and document requests
- Mitigating liability through proactive remediation
- Using civil money penalties and exclusion authority
Module 13: Specialised Payment Domains - Healthcare claims integrity: coding, bundling, and medical necessity
- Government grant and subsidy payment verification
- Procurement and vendor payment validation
- Payroll integrity: ghost employees and overtime abuse
- Travel and expense reimbursement audits
- Insurance claims processing controls
- Tax refund verification and fraud prevention
- Grant disbursement monitoring in non-profits
- Construction draw payment validation
- Utility and service billing accuracy checks
Module 14: Automation and Artificial Intelligence Applications - Machine learning models for anomaly detection
- Natural language processing for unstructured claim notes
- Robotic process automation for payment reconciliations
- AI-powered vendor risk profiling
- Automated document classification and extraction
- Continuous monitoring vs. periodic review systems
- Training models on historical improper payment data
- Ethical considerations in algorithmic decision-making
- Monitoring AI model drift and performance decay
- Human-in-the-loop validation for automated findings
Module 15: Cross-Organisational Collaboration - Aligning payment integrity with procurement strategy
- Partnering with clinical teams on healthcare payment accuracy
- Integrating fraud detection with enterprise risk management
- Sharing intelligence with industry coalitions
- Establishing inter-agency data exchange agreements
- Joint task forces for multi-payer investigations
- Synchronising controls across subsidiaries and divisions
- Creating feedback loops from recovery to prevention
- Standardising definitions across departments
- Breaking down silos between finance and operations
Module 16: Program Evaluation and Maturity Assessment - Assessing your current payment integrity maturity level
- Five-stage model: ad hoc, reactive, defined, managed, optimised
- Gap analysis between current state and best practices
- Benchmarking against peer organisations
- Evaluating return on investment for program activities
- Customer satisfaction with vendor dispute resolution
- Employee adoption rates of integrity protocols
- Reduction in improper payment rates over time
- Improvement in detection-to-recovery cycle times
- Strategic roadmap for advancing maturity
Module 17: Real-World Case Studies and Simulations - Case study: $12M recovery from duplicate Medicaid payments
- Simulation: Responding to a multi-state provider billing scheme
- Case study: Preventing $8M in fraudulent grant disbursements
- Simulation: Investigating a payroll ghost employee ring
- Case study: Reducing ER visit overpayments by 75%
- Simulation: Auditing construction project draw requests
- Case study: Stopping prescription fraud through data linkage
- Simulation: Handling a vendor dispute over overpayment demand
- Case study: Detecting collusion among transportation vendors
- Simulation: Preparing for a federal audit of program integrity
Module 18: Hands-On Project: Build Your Payment Integrity Plan - Step 1: Define your organisational context and scope
- Step 2: Conduct a custom risk assessment
- Step 3: Select detection methods for priority areas
- Step 4: Design recovery workflows and timelines
- Step 5: Draft policy and procedural documentation
- Step 6: Create an implementation timeline
- Step 7: Develop stakeholder communication plan
- Step 8: Build executive dashboard with key metrics
- Step 9: Identify training and change management needs
- Step 10: Finalise and present your complete plan
Module 19: Certification Preparation and Submission - Review of all core payment integrity competencies
- Guidelines for submitting your final project
- Formatting requirements for professional presentation
- Checklist for ensuring completeness and clarity
- Feedback process for iterative improvement
- Scheduling your certification review
- What examiners look for in high-scoring submissions
- Avoiding common mistakes in plan development
- How to demonstrate impact and feasibility
- Final preparation before submission to The Art of Service
Module 20: Beyond Certification - Career Advancement and Industry Recognition - Leveraging your Certificate of Completion for promotions
- Networking with certified peers in the alumni community
- Presenting your work at industry conferences
- Publishing case studies and white papers
- Becoming a subject matter expert in your organisation
- Mentoring junior staff in payment integrity practices
- Contributing to regulatory comment periods
- Joining government advisory panels
- Transitioning into consulting or auditing roles
- Staying current with ongoing updates and advanced modules
- Definition and scope of payment integrity in modern organisations
- Evolution of improper payments across healthcare, government, and corporate sectors
- Core principles: prevention, detection, recovery, and deterrence
- Understanding the payment lifecycle from initiation to settlement
- Key stakeholders in payment integrity: finance, compliance, audit, legal, and IT
- Differentiating fraud, waste, abuse, and administrative error
- Global regulatory landscape and mandatory reporting requirements
- Impact of improper payments on financial performance and reputation
- Fundamentals of internal controls within payment systems
- Role of governance frameworks in sustaining integrity programs
Module 2: Risk Assessment and Vulnerability Mapping - Conducting a comprehensive payment risk assessment
- Identifying high-risk transaction types and vendor categories
- Mapping vulnerabilities across procurement, claims, payroll, and grants
- Using risk scoring models to prioritise intervention areas
- Data-driven identification of anomaly patterns
- Common red flags in vendor billing behaviours
- Benchmarking against industry-specific leakage rates
- Assessing third-party vendor exposure and contract compliance
- Internal threat vectors: employee collusion and process bypasses
- Documenting findings in a formal risk register
Module 3: Detection Methodologies and Analytical Techniques - Overview of active vs. passive detection strategies
- Rule-based logic for identifying duplicate payments
- Algorithmic detection of overbilling and upcoding
- Statistical outlier analysis for identifying unusual claims
- Time-series analysis to detect recurring improper patterns
- Network analysis for uncovering vendor collusion rings
- Benford’s Law application in payment data validation
- Threshold monitoring and exception reporting systems
- Automated alert configuration and escalation workflows
- Integrating detection logic into existing ERP platforms
Module 4: Data Management and System Integration - Essential data fields for payment integrity analysis
- Standardising data formats across disparate sources
- Building a centralised payment integrity data repository
- ETL processes for extracting, transforming, and loading financial data
- Ensuring data accuracy, completeness, and timeliness
- Data governance policies for maintaining integrity standards
- API integration with core financial and claims systems
- Secure data handling and compliance with privacy regulations
- Using data dictionaries and metadata management
- Creating repeatable data pipelines for ongoing monitoring
Module 5: Policy Development and Compliance Alignment - Drafting a corporate payment integrity policy statement
- Aligning with HIPAA, False Claims Act, and OMB guidance
- Establishing mandatory review procedures for high-dollar payments
- Setting clear roles and responsibilities for oversight
- Developing escalation pathways for suspected misconduct
- Creating standard operating procedures for investigations
- Incorporating whistleblower protections and reporting mechanisms
- Ensuring alignment with SOX, GDPR, and other compliance regimes
- Documentation standards for audit readiness
- Maintaining policy version control and review cycles
Module 6: Fraud Prevention Frameworks and Controls - Pre-payment vs. post-payment control strategies
- Vendor credential checks and real-time validation
- Implementing mandatory supporting documentation requirements
- Designing dual approval workflows for high-risk transactions
- Using automated holds and payment suspensions
- Restricting access based on segregation of duties
- Preventing shell company infiltration through KYC protocols
- Embedding fraud awareness into procurement training
- Monitoring for duplicate tax IDs and bank accounts
- Using predictive analytics to flag high-risk payments pre-release
Module 7: Recovery Operations and Reconciliation - Developing a structured overpayment recovery protocol
- Calculating recovery amounts including interest and penalties
- Drafting demand letters and repayment agreements
- Negotiating settlements with vendors and providers
- Tracking recoveries in a central case management system
- Reconciliation of recovered funds into general ledger
- Reporting recovery metrics to executive leadership
- Establishing time limits for recovery actions
- Handling disputes and appeals from vendors
- Documenting closure of recovery cases for audit trails
Module 8: Technology Platforms and Tool Selection - Evaluating payment integrity software vendors
- Key features to look for in detection and recovery platforms
- Cost-benefit analysis of in-house vs. outsourced solutions
- Integration capabilities with existing financial systems
- Cloud-based vs. on-premise deployment trade-offs
- Vendor due diligence and security certification checks
- Proof-of-concept testing and pilot program design
- Change management strategies for system adoption
- User access controls and role-based permissions
- Troubleshooting common integration errors
Module 9: Team Structure and Operational Models - Designing an internal payment integrity team
- Determining staffing levels based on transaction volume
- Hiring profiles: auditors, analysts, investigators, and managers
- Outsourcing vs. insourcing decision framework
- Hybrid models combining internal oversight and external partners
- Defining KPIs for team performance measurement
- Creating shift schedules for 24/7 monitoring environments
- Establishing interdepartmental communication channels
- Developing escalation trees for urgent findings
- Training plans for new team members
Module 10: Audit and Quality Assurance Protocols - Conducting random payment audits to test control effectiveness
- Sampling methodologies for statistically valid results
- Creating an annual audit plan aligned with risk rankings
- Peer review processes for detection findings
- Quality scoring for investigation reports
- Back-testing detection rules for accuracy and precision
- Measuring false positive and false negative rates
- Corrective action planning for audit deficiencies
- Maintaining audit trail documentation
- Preparing for external regulatory examinations
Module 11: Stakeholder Communication and Executive Reporting - Designing board-level dashboards for payment integrity
- Translating technical findings into business impact
- Monthly reporting templates for CFOs and compliance officers
- Presenting ROI of recovery and prevention efforts
- Storytelling with data to gain leadership buy-in
- Communicating program success across departments
- Drafting press statements for public sector disclosures
- Managing media inquiries about payment errors
- Building trust through transparency and accountability
- Creating shareable summaries for non-technical audiences
Module 12: Legal and Investigative Procedures - When to escalate from error to suspected fraud
- Working with internal legal and compliance counsel
- Preserving evidence for potential litigation
- Conducting interviews with vendors and employees
- Chain of custody protocols for digital records
- Referring cases to law enforcement or regulators
- Coordinating with OIG, DOJ, and state agencies
- Responding to subpoenas and document requests
- Mitigating liability through proactive remediation
- Using civil money penalties and exclusion authority
Module 13: Specialised Payment Domains - Healthcare claims integrity: coding, bundling, and medical necessity
- Government grant and subsidy payment verification
- Procurement and vendor payment validation
- Payroll integrity: ghost employees and overtime abuse
- Travel and expense reimbursement audits
- Insurance claims processing controls
- Tax refund verification and fraud prevention
- Grant disbursement monitoring in non-profits
- Construction draw payment validation
- Utility and service billing accuracy checks
Module 14: Automation and Artificial Intelligence Applications - Machine learning models for anomaly detection
- Natural language processing for unstructured claim notes
- Robotic process automation for payment reconciliations
- AI-powered vendor risk profiling
- Automated document classification and extraction
- Continuous monitoring vs. periodic review systems
- Training models on historical improper payment data
- Ethical considerations in algorithmic decision-making
- Monitoring AI model drift and performance decay
- Human-in-the-loop validation for automated findings
Module 15: Cross-Organisational Collaboration - Aligning payment integrity with procurement strategy
- Partnering with clinical teams on healthcare payment accuracy
- Integrating fraud detection with enterprise risk management
- Sharing intelligence with industry coalitions
- Establishing inter-agency data exchange agreements
- Joint task forces for multi-payer investigations
- Synchronising controls across subsidiaries and divisions
- Creating feedback loops from recovery to prevention
- Standardising definitions across departments
- Breaking down silos between finance and operations
Module 16: Program Evaluation and Maturity Assessment - Assessing your current payment integrity maturity level
- Five-stage model: ad hoc, reactive, defined, managed, optimised
- Gap analysis between current state and best practices
- Benchmarking against peer organisations
- Evaluating return on investment for program activities
- Customer satisfaction with vendor dispute resolution
- Employee adoption rates of integrity protocols
- Reduction in improper payment rates over time
- Improvement in detection-to-recovery cycle times
- Strategic roadmap for advancing maturity
Module 17: Real-World Case Studies and Simulations - Case study: $12M recovery from duplicate Medicaid payments
- Simulation: Responding to a multi-state provider billing scheme
- Case study: Preventing $8M in fraudulent grant disbursements
- Simulation: Investigating a payroll ghost employee ring
- Case study: Reducing ER visit overpayments by 75%
- Simulation: Auditing construction project draw requests
- Case study: Stopping prescription fraud through data linkage
- Simulation: Handling a vendor dispute over overpayment demand
- Case study: Detecting collusion among transportation vendors
- Simulation: Preparing for a federal audit of program integrity
Module 18: Hands-On Project: Build Your Payment Integrity Plan - Step 1: Define your organisational context and scope
- Step 2: Conduct a custom risk assessment
- Step 3: Select detection methods for priority areas
- Step 4: Design recovery workflows and timelines
- Step 5: Draft policy and procedural documentation
- Step 6: Create an implementation timeline
- Step 7: Develop stakeholder communication plan
- Step 8: Build executive dashboard with key metrics
- Step 9: Identify training and change management needs
- Step 10: Finalise and present your complete plan
Module 19: Certification Preparation and Submission - Review of all core payment integrity competencies
- Guidelines for submitting your final project
- Formatting requirements for professional presentation
- Checklist for ensuring completeness and clarity
- Feedback process for iterative improvement
- Scheduling your certification review
- What examiners look for in high-scoring submissions
- Avoiding common mistakes in plan development
- How to demonstrate impact and feasibility
- Final preparation before submission to The Art of Service
Module 20: Beyond Certification - Career Advancement and Industry Recognition - Leveraging your Certificate of Completion for promotions
- Networking with certified peers in the alumni community
- Presenting your work at industry conferences
- Publishing case studies and white papers
- Becoming a subject matter expert in your organisation
- Mentoring junior staff in payment integrity practices
- Contributing to regulatory comment periods
- Joining government advisory panels
- Transitioning into consulting or auditing roles
- Staying current with ongoing updates and advanced modules
- Overview of active vs. passive detection strategies
- Rule-based logic for identifying duplicate payments
- Algorithmic detection of overbilling and upcoding
- Statistical outlier analysis for identifying unusual claims
- Time-series analysis to detect recurring improper patterns
- Network analysis for uncovering vendor collusion rings
- Benford’s Law application in payment data validation
- Threshold monitoring and exception reporting systems
- Automated alert configuration and escalation workflows
- Integrating detection logic into existing ERP platforms
Module 4: Data Management and System Integration - Essential data fields for payment integrity analysis
- Standardising data formats across disparate sources
- Building a centralised payment integrity data repository
- ETL processes for extracting, transforming, and loading financial data
- Ensuring data accuracy, completeness, and timeliness
- Data governance policies for maintaining integrity standards
- API integration with core financial and claims systems
- Secure data handling and compliance with privacy regulations
- Using data dictionaries and metadata management
- Creating repeatable data pipelines for ongoing monitoring
Module 5: Policy Development and Compliance Alignment - Drafting a corporate payment integrity policy statement
- Aligning with HIPAA, False Claims Act, and OMB guidance
- Establishing mandatory review procedures for high-dollar payments
- Setting clear roles and responsibilities for oversight
- Developing escalation pathways for suspected misconduct
- Creating standard operating procedures for investigations
- Incorporating whistleblower protections and reporting mechanisms
- Ensuring alignment with SOX, GDPR, and other compliance regimes
- Documentation standards for audit readiness
- Maintaining policy version control and review cycles
Module 6: Fraud Prevention Frameworks and Controls - Pre-payment vs. post-payment control strategies
- Vendor credential checks and real-time validation
- Implementing mandatory supporting documentation requirements
- Designing dual approval workflows for high-risk transactions
- Using automated holds and payment suspensions
- Restricting access based on segregation of duties
- Preventing shell company infiltration through KYC protocols
- Embedding fraud awareness into procurement training
- Monitoring for duplicate tax IDs and bank accounts
- Using predictive analytics to flag high-risk payments pre-release
Module 7: Recovery Operations and Reconciliation - Developing a structured overpayment recovery protocol
- Calculating recovery amounts including interest and penalties
- Drafting demand letters and repayment agreements
- Negotiating settlements with vendors and providers
- Tracking recoveries in a central case management system
- Reconciliation of recovered funds into general ledger
- Reporting recovery metrics to executive leadership
- Establishing time limits for recovery actions
- Handling disputes and appeals from vendors
- Documenting closure of recovery cases for audit trails
Module 8: Technology Platforms and Tool Selection - Evaluating payment integrity software vendors
- Key features to look for in detection and recovery platforms
- Cost-benefit analysis of in-house vs. outsourced solutions
- Integration capabilities with existing financial systems
- Cloud-based vs. on-premise deployment trade-offs
- Vendor due diligence and security certification checks
- Proof-of-concept testing and pilot program design
- Change management strategies for system adoption
- User access controls and role-based permissions
- Troubleshooting common integration errors
Module 9: Team Structure and Operational Models - Designing an internal payment integrity team
- Determining staffing levels based on transaction volume
- Hiring profiles: auditors, analysts, investigators, and managers
- Outsourcing vs. insourcing decision framework
- Hybrid models combining internal oversight and external partners
- Defining KPIs for team performance measurement
- Creating shift schedules for 24/7 monitoring environments
- Establishing interdepartmental communication channels
- Developing escalation trees for urgent findings
- Training plans for new team members
Module 10: Audit and Quality Assurance Protocols - Conducting random payment audits to test control effectiveness
- Sampling methodologies for statistically valid results
- Creating an annual audit plan aligned with risk rankings
- Peer review processes for detection findings
- Quality scoring for investigation reports
- Back-testing detection rules for accuracy and precision
- Measuring false positive and false negative rates
- Corrective action planning for audit deficiencies
- Maintaining audit trail documentation
- Preparing for external regulatory examinations
Module 11: Stakeholder Communication and Executive Reporting - Designing board-level dashboards for payment integrity
- Translating technical findings into business impact
- Monthly reporting templates for CFOs and compliance officers
- Presenting ROI of recovery and prevention efforts
- Storytelling with data to gain leadership buy-in
- Communicating program success across departments
- Drafting press statements for public sector disclosures
- Managing media inquiries about payment errors
- Building trust through transparency and accountability
- Creating shareable summaries for non-technical audiences
Module 12: Legal and Investigative Procedures - When to escalate from error to suspected fraud
- Working with internal legal and compliance counsel
- Preserving evidence for potential litigation
- Conducting interviews with vendors and employees
- Chain of custody protocols for digital records
- Referring cases to law enforcement or regulators
- Coordinating with OIG, DOJ, and state agencies
- Responding to subpoenas and document requests
- Mitigating liability through proactive remediation
- Using civil money penalties and exclusion authority
Module 13: Specialised Payment Domains - Healthcare claims integrity: coding, bundling, and medical necessity
- Government grant and subsidy payment verification
- Procurement and vendor payment validation
- Payroll integrity: ghost employees and overtime abuse
- Travel and expense reimbursement audits
- Insurance claims processing controls
- Tax refund verification and fraud prevention
- Grant disbursement monitoring in non-profits
- Construction draw payment validation
- Utility and service billing accuracy checks
Module 14: Automation and Artificial Intelligence Applications - Machine learning models for anomaly detection
- Natural language processing for unstructured claim notes
- Robotic process automation for payment reconciliations
- AI-powered vendor risk profiling
- Automated document classification and extraction
- Continuous monitoring vs. periodic review systems
- Training models on historical improper payment data
- Ethical considerations in algorithmic decision-making
- Monitoring AI model drift and performance decay
- Human-in-the-loop validation for automated findings
Module 15: Cross-Organisational Collaboration - Aligning payment integrity with procurement strategy
- Partnering with clinical teams on healthcare payment accuracy
- Integrating fraud detection with enterprise risk management
- Sharing intelligence with industry coalitions
- Establishing inter-agency data exchange agreements
- Joint task forces for multi-payer investigations
- Synchronising controls across subsidiaries and divisions
- Creating feedback loops from recovery to prevention
- Standardising definitions across departments
- Breaking down silos between finance and operations
Module 16: Program Evaluation and Maturity Assessment - Assessing your current payment integrity maturity level
- Five-stage model: ad hoc, reactive, defined, managed, optimised
- Gap analysis between current state and best practices
- Benchmarking against peer organisations
- Evaluating return on investment for program activities
- Customer satisfaction with vendor dispute resolution
- Employee adoption rates of integrity protocols
- Reduction in improper payment rates over time
- Improvement in detection-to-recovery cycle times
- Strategic roadmap for advancing maturity
Module 17: Real-World Case Studies and Simulations - Case study: $12M recovery from duplicate Medicaid payments
- Simulation: Responding to a multi-state provider billing scheme
- Case study: Preventing $8M in fraudulent grant disbursements
- Simulation: Investigating a payroll ghost employee ring
- Case study: Reducing ER visit overpayments by 75%
- Simulation: Auditing construction project draw requests
- Case study: Stopping prescription fraud through data linkage
- Simulation: Handling a vendor dispute over overpayment demand
- Case study: Detecting collusion among transportation vendors
- Simulation: Preparing for a federal audit of program integrity
Module 18: Hands-On Project: Build Your Payment Integrity Plan - Step 1: Define your organisational context and scope
- Step 2: Conduct a custom risk assessment
- Step 3: Select detection methods for priority areas
- Step 4: Design recovery workflows and timelines
- Step 5: Draft policy and procedural documentation
- Step 6: Create an implementation timeline
- Step 7: Develop stakeholder communication plan
- Step 8: Build executive dashboard with key metrics
- Step 9: Identify training and change management needs
- Step 10: Finalise and present your complete plan
Module 19: Certification Preparation and Submission - Review of all core payment integrity competencies
- Guidelines for submitting your final project
- Formatting requirements for professional presentation
- Checklist for ensuring completeness and clarity
- Feedback process for iterative improvement
- Scheduling your certification review
- What examiners look for in high-scoring submissions
- Avoiding common mistakes in plan development
- How to demonstrate impact and feasibility
- Final preparation before submission to The Art of Service
Module 20: Beyond Certification - Career Advancement and Industry Recognition - Leveraging your Certificate of Completion for promotions
- Networking with certified peers in the alumni community
- Presenting your work at industry conferences
- Publishing case studies and white papers
- Becoming a subject matter expert in your organisation
- Mentoring junior staff in payment integrity practices
- Contributing to regulatory comment periods
- Joining government advisory panels
- Transitioning into consulting or auditing roles
- Staying current with ongoing updates and advanced modules
- Drafting a corporate payment integrity policy statement
- Aligning with HIPAA, False Claims Act, and OMB guidance
- Establishing mandatory review procedures for high-dollar payments
- Setting clear roles and responsibilities for oversight
- Developing escalation pathways for suspected misconduct
- Creating standard operating procedures for investigations
- Incorporating whistleblower protections and reporting mechanisms
- Ensuring alignment with SOX, GDPR, and other compliance regimes
- Documentation standards for audit readiness
- Maintaining policy version control and review cycles
Module 6: Fraud Prevention Frameworks and Controls - Pre-payment vs. post-payment control strategies
- Vendor credential checks and real-time validation
- Implementing mandatory supporting documentation requirements
- Designing dual approval workflows for high-risk transactions
- Using automated holds and payment suspensions
- Restricting access based on segregation of duties
- Preventing shell company infiltration through KYC protocols
- Embedding fraud awareness into procurement training
- Monitoring for duplicate tax IDs and bank accounts
- Using predictive analytics to flag high-risk payments pre-release
Module 7: Recovery Operations and Reconciliation - Developing a structured overpayment recovery protocol
- Calculating recovery amounts including interest and penalties
- Drafting demand letters and repayment agreements
- Negotiating settlements with vendors and providers
- Tracking recoveries in a central case management system
- Reconciliation of recovered funds into general ledger
- Reporting recovery metrics to executive leadership
- Establishing time limits for recovery actions
- Handling disputes and appeals from vendors
- Documenting closure of recovery cases for audit trails
Module 8: Technology Platforms and Tool Selection - Evaluating payment integrity software vendors
- Key features to look for in detection and recovery platforms
- Cost-benefit analysis of in-house vs. outsourced solutions
- Integration capabilities with existing financial systems
- Cloud-based vs. on-premise deployment trade-offs
- Vendor due diligence and security certification checks
- Proof-of-concept testing and pilot program design
- Change management strategies for system adoption
- User access controls and role-based permissions
- Troubleshooting common integration errors
Module 9: Team Structure and Operational Models - Designing an internal payment integrity team
- Determining staffing levels based on transaction volume
- Hiring profiles: auditors, analysts, investigators, and managers
- Outsourcing vs. insourcing decision framework
- Hybrid models combining internal oversight and external partners
- Defining KPIs for team performance measurement
- Creating shift schedules for 24/7 monitoring environments
- Establishing interdepartmental communication channels
- Developing escalation trees for urgent findings
- Training plans for new team members
Module 10: Audit and Quality Assurance Protocols - Conducting random payment audits to test control effectiveness
- Sampling methodologies for statistically valid results
- Creating an annual audit plan aligned with risk rankings
- Peer review processes for detection findings
- Quality scoring for investigation reports
- Back-testing detection rules for accuracy and precision
- Measuring false positive and false negative rates
- Corrective action planning for audit deficiencies
- Maintaining audit trail documentation
- Preparing for external regulatory examinations
Module 11: Stakeholder Communication and Executive Reporting - Designing board-level dashboards for payment integrity
- Translating technical findings into business impact
- Monthly reporting templates for CFOs and compliance officers
- Presenting ROI of recovery and prevention efforts
- Storytelling with data to gain leadership buy-in
- Communicating program success across departments
- Drafting press statements for public sector disclosures
- Managing media inquiries about payment errors
- Building trust through transparency and accountability
- Creating shareable summaries for non-technical audiences
Module 12: Legal and Investigative Procedures - When to escalate from error to suspected fraud
- Working with internal legal and compliance counsel
- Preserving evidence for potential litigation
- Conducting interviews with vendors and employees
- Chain of custody protocols for digital records
- Referring cases to law enforcement or regulators
- Coordinating with OIG, DOJ, and state agencies
- Responding to subpoenas and document requests
- Mitigating liability through proactive remediation
- Using civil money penalties and exclusion authority
Module 13: Specialised Payment Domains - Healthcare claims integrity: coding, bundling, and medical necessity
- Government grant and subsidy payment verification
- Procurement and vendor payment validation
- Payroll integrity: ghost employees and overtime abuse
- Travel and expense reimbursement audits
- Insurance claims processing controls
- Tax refund verification and fraud prevention
- Grant disbursement monitoring in non-profits
- Construction draw payment validation
- Utility and service billing accuracy checks
Module 14: Automation and Artificial Intelligence Applications - Machine learning models for anomaly detection
- Natural language processing for unstructured claim notes
- Robotic process automation for payment reconciliations
- AI-powered vendor risk profiling
- Automated document classification and extraction
- Continuous monitoring vs. periodic review systems
- Training models on historical improper payment data
- Ethical considerations in algorithmic decision-making
- Monitoring AI model drift and performance decay
- Human-in-the-loop validation for automated findings
Module 15: Cross-Organisational Collaboration - Aligning payment integrity with procurement strategy
- Partnering with clinical teams on healthcare payment accuracy
- Integrating fraud detection with enterprise risk management
- Sharing intelligence with industry coalitions
- Establishing inter-agency data exchange agreements
- Joint task forces for multi-payer investigations
- Synchronising controls across subsidiaries and divisions
- Creating feedback loops from recovery to prevention
- Standardising definitions across departments
- Breaking down silos between finance and operations
Module 16: Program Evaluation and Maturity Assessment - Assessing your current payment integrity maturity level
- Five-stage model: ad hoc, reactive, defined, managed, optimised
- Gap analysis between current state and best practices
- Benchmarking against peer organisations
- Evaluating return on investment for program activities
- Customer satisfaction with vendor dispute resolution
- Employee adoption rates of integrity protocols
- Reduction in improper payment rates over time
- Improvement in detection-to-recovery cycle times
- Strategic roadmap for advancing maturity
Module 17: Real-World Case Studies and Simulations - Case study: $12M recovery from duplicate Medicaid payments
- Simulation: Responding to a multi-state provider billing scheme
- Case study: Preventing $8M in fraudulent grant disbursements
- Simulation: Investigating a payroll ghost employee ring
- Case study: Reducing ER visit overpayments by 75%
- Simulation: Auditing construction project draw requests
- Case study: Stopping prescription fraud through data linkage
- Simulation: Handling a vendor dispute over overpayment demand
- Case study: Detecting collusion among transportation vendors
- Simulation: Preparing for a federal audit of program integrity
Module 18: Hands-On Project: Build Your Payment Integrity Plan - Step 1: Define your organisational context and scope
- Step 2: Conduct a custom risk assessment
- Step 3: Select detection methods for priority areas
- Step 4: Design recovery workflows and timelines
- Step 5: Draft policy and procedural documentation
- Step 6: Create an implementation timeline
- Step 7: Develop stakeholder communication plan
- Step 8: Build executive dashboard with key metrics
- Step 9: Identify training and change management needs
- Step 10: Finalise and present your complete plan
Module 19: Certification Preparation and Submission - Review of all core payment integrity competencies
- Guidelines for submitting your final project
- Formatting requirements for professional presentation
- Checklist for ensuring completeness and clarity
- Feedback process for iterative improvement
- Scheduling your certification review
- What examiners look for in high-scoring submissions
- Avoiding common mistakes in plan development
- How to demonstrate impact and feasibility
- Final preparation before submission to The Art of Service
Module 20: Beyond Certification - Career Advancement and Industry Recognition - Leveraging your Certificate of Completion for promotions
- Networking with certified peers in the alumni community
- Presenting your work at industry conferences
- Publishing case studies and white papers
- Becoming a subject matter expert in your organisation
- Mentoring junior staff in payment integrity practices
- Contributing to regulatory comment periods
- Joining government advisory panels
- Transitioning into consulting or auditing roles
- Staying current with ongoing updates and advanced modules
- Developing a structured overpayment recovery protocol
- Calculating recovery amounts including interest and penalties
- Drafting demand letters and repayment agreements
- Negotiating settlements with vendors and providers
- Tracking recoveries in a central case management system
- Reconciliation of recovered funds into general ledger
- Reporting recovery metrics to executive leadership
- Establishing time limits for recovery actions
- Handling disputes and appeals from vendors
- Documenting closure of recovery cases for audit trails
Module 8: Technology Platforms and Tool Selection - Evaluating payment integrity software vendors
- Key features to look for in detection and recovery platforms
- Cost-benefit analysis of in-house vs. outsourced solutions
- Integration capabilities with existing financial systems
- Cloud-based vs. on-premise deployment trade-offs
- Vendor due diligence and security certification checks
- Proof-of-concept testing and pilot program design
- Change management strategies for system adoption
- User access controls and role-based permissions
- Troubleshooting common integration errors
Module 9: Team Structure and Operational Models - Designing an internal payment integrity team
- Determining staffing levels based on transaction volume
- Hiring profiles: auditors, analysts, investigators, and managers
- Outsourcing vs. insourcing decision framework
- Hybrid models combining internal oversight and external partners
- Defining KPIs for team performance measurement
- Creating shift schedules for 24/7 monitoring environments
- Establishing interdepartmental communication channels
- Developing escalation trees for urgent findings
- Training plans for new team members
Module 10: Audit and Quality Assurance Protocols - Conducting random payment audits to test control effectiveness
- Sampling methodologies for statistically valid results
- Creating an annual audit plan aligned with risk rankings
- Peer review processes for detection findings
- Quality scoring for investigation reports
- Back-testing detection rules for accuracy and precision
- Measuring false positive and false negative rates
- Corrective action planning for audit deficiencies
- Maintaining audit trail documentation
- Preparing for external regulatory examinations
Module 11: Stakeholder Communication and Executive Reporting - Designing board-level dashboards for payment integrity
- Translating technical findings into business impact
- Monthly reporting templates for CFOs and compliance officers
- Presenting ROI of recovery and prevention efforts
- Storytelling with data to gain leadership buy-in
- Communicating program success across departments
- Drafting press statements for public sector disclosures
- Managing media inquiries about payment errors
- Building trust through transparency and accountability
- Creating shareable summaries for non-technical audiences
Module 12: Legal and Investigative Procedures - When to escalate from error to suspected fraud
- Working with internal legal and compliance counsel
- Preserving evidence for potential litigation
- Conducting interviews with vendors and employees
- Chain of custody protocols for digital records
- Referring cases to law enforcement or regulators
- Coordinating with OIG, DOJ, and state agencies
- Responding to subpoenas and document requests
- Mitigating liability through proactive remediation
- Using civil money penalties and exclusion authority
Module 13: Specialised Payment Domains - Healthcare claims integrity: coding, bundling, and medical necessity
- Government grant and subsidy payment verification
- Procurement and vendor payment validation
- Payroll integrity: ghost employees and overtime abuse
- Travel and expense reimbursement audits
- Insurance claims processing controls
- Tax refund verification and fraud prevention
- Grant disbursement monitoring in non-profits
- Construction draw payment validation
- Utility and service billing accuracy checks
Module 14: Automation and Artificial Intelligence Applications - Machine learning models for anomaly detection
- Natural language processing for unstructured claim notes
- Robotic process automation for payment reconciliations
- AI-powered vendor risk profiling
- Automated document classification and extraction
- Continuous monitoring vs. periodic review systems
- Training models on historical improper payment data
- Ethical considerations in algorithmic decision-making
- Monitoring AI model drift and performance decay
- Human-in-the-loop validation for automated findings
Module 15: Cross-Organisational Collaboration - Aligning payment integrity with procurement strategy
- Partnering with clinical teams on healthcare payment accuracy
- Integrating fraud detection with enterprise risk management
- Sharing intelligence with industry coalitions
- Establishing inter-agency data exchange agreements
- Joint task forces for multi-payer investigations
- Synchronising controls across subsidiaries and divisions
- Creating feedback loops from recovery to prevention
- Standardising definitions across departments
- Breaking down silos between finance and operations
Module 16: Program Evaluation and Maturity Assessment - Assessing your current payment integrity maturity level
- Five-stage model: ad hoc, reactive, defined, managed, optimised
- Gap analysis between current state and best practices
- Benchmarking against peer organisations
- Evaluating return on investment for program activities
- Customer satisfaction with vendor dispute resolution
- Employee adoption rates of integrity protocols
- Reduction in improper payment rates over time
- Improvement in detection-to-recovery cycle times
- Strategic roadmap for advancing maturity
Module 17: Real-World Case Studies and Simulations - Case study: $12M recovery from duplicate Medicaid payments
- Simulation: Responding to a multi-state provider billing scheme
- Case study: Preventing $8M in fraudulent grant disbursements
- Simulation: Investigating a payroll ghost employee ring
- Case study: Reducing ER visit overpayments by 75%
- Simulation: Auditing construction project draw requests
- Case study: Stopping prescription fraud through data linkage
- Simulation: Handling a vendor dispute over overpayment demand
- Case study: Detecting collusion among transportation vendors
- Simulation: Preparing for a federal audit of program integrity
Module 18: Hands-On Project: Build Your Payment Integrity Plan - Step 1: Define your organisational context and scope
- Step 2: Conduct a custom risk assessment
- Step 3: Select detection methods for priority areas
- Step 4: Design recovery workflows and timelines
- Step 5: Draft policy and procedural documentation
- Step 6: Create an implementation timeline
- Step 7: Develop stakeholder communication plan
- Step 8: Build executive dashboard with key metrics
- Step 9: Identify training and change management needs
- Step 10: Finalise and present your complete plan
Module 19: Certification Preparation and Submission - Review of all core payment integrity competencies
- Guidelines for submitting your final project
- Formatting requirements for professional presentation
- Checklist for ensuring completeness and clarity
- Feedback process for iterative improvement
- Scheduling your certification review
- What examiners look for in high-scoring submissions
- Avoiding common mistakes in plan development
- How to demonstrate impact and feasibility
- Final preparation before submission to The Art of Service
Module 20: Beyond Certification - Career Advancement and Industry Recognition - Leveraging your Certificate of Completion for promotions
- Networking with certified peers in the alumni community
- Presenting your work at industry conferences
- Publishing case studies and white papers
- Becoming a subject matter expert in your organisation
- Mentoring junior staff in payment integrity practices
- Contributing to regulatory comment periods
- Joining government advisory panels
- Transitioning into consulting or auditing roles
- Staying current with ongoing updates and advanced modules
- Designing an internal payment integrity team
- Determining staffing levels based on transaction volume
- Hiring profiles: auditors, analysts, investigators, and managers
- Outsourcing vs. insourcing decision framework
- Hybrid models combining internal oversight and external partners
- Defining KPIs for team performance measurement
- Creating shift schedules for 24/7 monitoring environments
- Establishing interdepartmental communication channels
- Developing escalation trees for urgent findings
- Training plans for new team members
Module 10: Audit and Quality Assurance Protocols - Conducting random payment audits to test control effectiveness
- Sampling methodologies for statistically valid results
- Creating an annual audit plan aligned with risk rankings
- Peer review processes for detection findings
- Quality scoring for investigation reports
- Back-testing detection rules for accuracy and precision
- Measuring false positive and false negative rates
- Corrective action planning for audit deficiencies
- Maintaining audit trail documentation
- Preparing for external regulatory examinations
Module 11: Stakeholder Communication and Executive Reporting - Designing board-level dashboards for payment integrity
- Translating technical findings into business impact
- Monthly reporting templates for CFOs and compliance officers
- Presenting ROI of recovery and prevention efforts
- Storytelling with data to gain leadership buy-in
- Communicating program success across departments
- Drafting press statements for public sector disclosures
- Managing media inquiries about payment errors
- Building trust through transparency and accountability
- Creating shareable summaries for non-technical audiences
Module 12: Legal and Investigative Procedures - When to escalate from error to suspected fraud
- Working with internal legal and compliance counsel
- Preserving evidence for potential litigation
- Conducting interviews with vendors and employees
- Chain of custody protocols for digital records
- Referring cases to law enforcement or regulators
- Coordinating with OIG, DOJ, and state agencies
- Responding to subpoenas and document requests
- Mitigating liability through proactive remediation
- Using civil money penalties and exclusion authority
Module 13: Specialised Payment Domains - Healthcare claims integrity: coding, bundling, and medical necessity
- Government grant and subsidy payment verification
- Procurement and vendor payment validation
- Payroll integrity: ghost employees and overtime abuse
- Travel and expense reimbursement audits
- Insurance claims processing controls
- Tax refund verification and fraud prevention
- Grant disbursement monitoring in non-profits
- Construction draw payment validation
- Utility and service billing accuracy checks
Module 14: Automation and Artificial Intelligence Applications - Machine learning models for anomaly detection
- Natural language processing for unstructured claim notes
- Robotic process automation for payment reconciliations
- AI-powered vendor risk profiling
- Automated document classification and extraction
- Continuous monitoring vs. periodic review systems
- Training models on historical improper payment data
- Ethical considerations in algorithmic decision-making
- Monitoring AI model drift and performance decay
- Human-in-the-loop validation for automated findings
Module 15: Cross-Organisational Collaboration - Aligning payment integrity with procurement strategy
- Partnering with clinical teams on healthcare payment accuracy
- Integrating fraud detection with enterprise risk management
- Sharing intelligence with industry coalitions
- Establishing inter-agency data exchange agreements
- Joint task forces for multi-payer investigations
- Synchronising controls across subsidiaries and divisions
- Creating feedback loops from recovery to prevention
- Standardising definitions across departments
- Breaking down silos between finance and operations
Module 16: Program Evaluation and Maturity Assessment - Assessing your current payment integrity maturity level
- Five-stage model: ad hoc, reactive, defined, managed, optimised
- Gap analysis between current state and best practices
- Benchmarking against peer organisations
- Evaluating return on investment for program activities
- Customer satisfaction with vendor dispute resolution
- Employee adoption rates of integrity protocols
- Reduction in improper payment rates over time
- Improvement in detection-to-recovery cycle times
- Strategic roadmap for advancing maturity
Module 17: Real-World Case Studies and Simulations - Case study: $12M recovery from duplicate Medicaid payments
- Simulation: Responding to a multi-state provider billing scheme
- Case study: Preventing $8M in fraudulent grant disbursements
- Simulation: Investigating a payroll ghost employee ring
- Case study: Reducing ER visit overpayments by 75%
- Simulation: Auditing construction project draw requests
- Case study: Stopping prescription fraud through data linkage
- Simulation: Handling a vendor dispute over overpayment demand
- Case study: Detecting collusion among transportation vendors
- Simulation: Preparing for a federal audit of program integrity
Module 18: Hands-On Project: Build Your Payment Integrity Plan - Step 1: Define your organisational context and scope
- Step 2: Conduct a custom risk assessment
- Step 3: Select detection methods for priority areas
- Step 4: Design recovery workflows and timelines
- Step 5: Draft policy and procedural documentation
- Step 6: Create an implementation timeline
- Step 7: Develop stakeholder communication plan
- Step 8: Build executive dashboard with key metrics
- Step 9: Identify training and change management needs
- Step 10: Finalise and present your complete plan
Module 19: Certification Preparation and Submission - Review of all core payment integrity competencies
- Guidelines for submitting your final project
- Formatting requirements for professional presentation
- Checklist for ensuring completeness and clarity
- Feedback process for iterative improvement
- Scheduling your certification review
- What examiners look for in high-scoring submissions
- Avoiding common mistakes in plan development
- How to demonstrate impact and feasibility
- Final preparation before submission to The Art of Service
Module 20: Beyond Certification - Career Advancement and Industry Recognition - Leveraging your Certificate of Completion for promotions
- Networking with certified peers in the alumni community
- Presenting your work at industry conferences
- Publishing case studies and white papers
- Becoming a subject matter expert in your organisation
- Mentoring junior staff in payment integrity practices
- Contributing to regulatory comment periods
- Joining government advisory panels
- Transitioning into consulting or auditing roles
- Staying current with ongoing updates and advanced modules
- Designing board-level dashboards for payment integrity
- Translating technical findings into business impact
- Monthly reporting templates for CFOs and compliance officers
- Presenting ROI of recovery and prevention efforts
- Storytelling with data to gain leadership buy-in
- Communicating program success across departments
- Drafting press statements for public sector disclosures
- Managing media inquiries about payment errors
- Building trust through transparency and accountability
- Creating shareable summaries for non-technical audiences
Module 12: Legal and Investigative Procedures - When to escalate from error to suspected fraud
- Working with internal legal and compliance counsel
- Preserving evidence for potential litigation
- Conducting interviews with vendors and employees
- Chain of custody protocols for digital records
- Referring cases to law enforcement or regulators
- Coordinating with OIG, DOJ, and state agencies
- Responding to subpoenas and document requests
- Mitigating liability through proactive remediation
- Using civil money penalties and exclusion authority
Module 13: Specialised Payment Domains - Healthcare claims integrity: coding, bundling, and medical necessity
- Government grant and subsidy payment verification
- Procurement and vendor payment validation
- Payroll integrity: ghost employees and overtime abuse
- Travel and expense reimbursement audits
- Insurance claims processing controls
- Tax refund verification and fraud prevention
- Grant disbursement monitoring in non-profits
- Construction draw payment validation
- Utility and service billing accuracy checks
Module 14: Automation and Artificial Intelligence Applications - Machine learning models for anomaly detection
- Natural language processing for unstructured claim notes
- Robotic process automation for payment reconciliations
- AI-powered vendor risk profiling
- Automated document classification and extraction
- Continuous monitoring vs. periodic review systems
- Training models on historical improper payment data
- Ethical considerations in algorithmic decision-making
- Monitoring AI model drift and performance decay
- Human-in-the-loop validation for automated findings
Module 15: Cross-Organisational Collaboration - Aligning payment integrity with procurement strategy
- Partnering with clinical teams on healthcare payment accuracy
- Integrating fraud detection with enterprise risk management
- Sharing intelligence with industry coalitions
- Establishing inter-agency data exchange agreements
- Joint task forces for multi-payer investigations
- Synchronising controls across subsidiaries and divisions
- Creating feedback loops from recovery to prevention
- Standardising definitions across departments
- Breaking down silos between finance and operations
Module 16: Program Evaluation and Maturity Assessment - Assessing your current payment integrity maturity level
- Five-stage model: ad hoc, reactive, defined, managed, optimised
- Gap analysis between current state and best practices
- Benchmarking against peer organisations
- Evaluating return on investment for program activities
- Customer satisfaction with vendor dispute resolution
- Employee adoption rates of integrity protocols
- Reduction in improper payment rates over time
- Improvement in detection-to-recovery cycle times
- Strategic roadmap for advancing maturity
Module 17: Real-World Case Studies and Simulations - Case study: $12M recovery from duplicate Medicaid payments
- Simulation: Responding to a multi-state provider billing scheme
- Case study: Preventing $8M in fraudulent grant disbursements
- Simulation: Investigating a payroll ghost employee ring
- Case study: Reducing ER visit overpayments by 75%
- Simulation: Auditing construction project draw requests
- Case study: Stopping prescription fraud through data linkage
- Simulation: Handling a vendor dispute over overpayment demand
- Case study: Detecting collusion among transportation vendors
- Simulation: Preparing for a federal audit of program integrity
Module 18: Hands-On Project: Build Your Payment Integrity Plan - Step 1: Define your organisational context and scope
- Step 2: Conduct a custom risk assessment
- Step 3: Select detection methods for priority areas
- Step 4: Design recovery workflows and timelines
- Step 5: Draft policy and procedural documentation
- Step 6: Create an implementation timeline
- Step 7: Develop stakeholder communication plan
- Step 8: Build executive dashboard with key metrics
- Step 9: Identify training and change management needs
- Step 10: Finalise and present your complete plan
Module 19: Certification Preparation and Submission - Review of all core payment integrity competencies
- Guidelines for submitting your final project
- Formatting requirements for professional presentation
- Checklist for ensuring completeness and clarity
- Feedback process for iterative improvement
- Scheduling your certification review
- What examiners look for in high-scoring submissions
- Avoiding common mistakes in plan development
- How to demonstrate impact and feasibility
- Final preparation before submission to The Art of Service
Module 20: Beyond Certification - Career Advancement and Industry Recognition - Leveraging your Certificate of Completion for promotions
- Networking with certified peers in the alumni community
- Presenting your work at industry conferences
- Publishing case studies and white papers
- Becoming a subject matter expert in your organisation
- Mentoring junior staff in payment integrity practices
- Contributing to regulatory comment periods
- Joining government advisory panels
- Transitioning into consulting or auditing roles
- Staying current with ongoing updates and advanced modules
- Healthcare claims integrity: coding, bundling, and medical necessity
- Government grant and subsidy payment verification
- Procurement and vendor payment validation
- Payroll integrity: ghost employees and overtime abuse
- Travel and expense reimbursement audits
- Insurance claims processing controls
- Tax refund verification and fraud prevention
- Grant disbursement monitoring in non-profits
- Construction draw payment validation
- Utility and service billing accuracy checks
Module 14: Automation and Artificial Intelligence Applications - Machine learning models for anomaly detection
- Natural language processing for unstructured claim notes
- Robotic process automation for payment reconciliations
- AI-powered vendor risk profiling
- Automated document classification and extraction
- Continuous monitoring vs. periodic review systems
- Training models on historical improper payment data
- Ethical considerations in algorithmic decision-making
- Monitoring AI model drift and performance decay
- Human-in-the-loop validation for automated findings
Module 15: Cross-Organisational Collaboration - Aligning payment integrity with procurement strategy
- Partnering with clinical teams on healthcare payment accuracy
- Integrating fraud detection with enterprise risk management
- Sharing intelligence with industry coalitions
- Establishing inter-agency data exchange agreements
- Joint task forces for multi-payer investigations
- Synchronising controls across subsidiaries and divisions
- Creating feedback loops from recovery to prevention
- Standardising definitions across departments
- Breaking down silos between finance and operations
Module 16: Program Evaluation and Maturity Assessment - Assessing your current payment integrity maturity level
- Five-stage model: ad hoc, reactive, defined, managed, optimised
- Gap analysis between current state and best practices
- Benchmarking against peer organisations
- Evaluating return on investment for program activities
- Customer satisfaction with vendor dispute resolution
- Employee adoption rates of integrity protocols
- Reduction in improper payment rates over time
- Improvement in detection-to-recovery cycle times
- Strategic roadmap for advancing maturity
Module 17: Real-World Case Studies and Simulations - Case study: $12M recovery from duplicate Medicaid payments
- Simulation: Responding to a multi-state provider billing scheme
- Case study: Preventing $8M in fraudulent grant disbursements
- Simulation: Investigating a payroll ghost employee ring
- Case study: Reducing ER visit overpayments by 75%
- Simulation: Auditing construction project draw requests
- Case study: Stopping prescription fraud through data linkage
- Simulation: Handling a vendor dispute over overpayment demand
- Case study: Detecting collusion among transportation vendors
- Simulation: Preparing for a federal audit of program integrity
Module 18: Hands-On Project: Build Your Payment Integrity Plan - Step 1: Define your organisational context and scope
- Step 2: Conduct a custom risk assessment
- Step 3: Select detection methods for priority areas
- Step 4: Design recovery workflows and timelines
- Step 5: Draft policy and procedural documentation
- Step 6: Create an implementation timeline
- Step 7: Develop stakeholder communication plan
- Step 8: Build executive dashboard with key metrics
- Step 9: Identify training and change management needs
- Step 10: Finalise and present your complete plan
Module 19: Certification Preparation and Submission - Review of all core payment integrity competencies
- Guidelines for submitting your final project
- Formatting requirements for professional presentation
- Checklist for ensuring completeness and clarity
- Feedback process for iterative improvement
- Scheduling your certification review
- What examiners look for in high-scoring submissions
- Avoiding common mistakes in plan development
- How to demonstrate impact and feasibility
- Final preparation before submission to The Art of Service
Module 20: Beyond Certification - Career Advancement and Industry Recognition - Leveraging your Certificate of Completion for promotions
- Networking with certified peers in the alumni community
- Presenting your work at industry conferences
- Publishing case studies and white papers
- Becoming a subject matter expert in your organisation
- Mentoring junior staff in payment integrity practices
- Contributing to regulatory comment periods
- Joining government advisory panels
- Transitioning into consulting or auditing roles
- Staying current with ongoing updates and advanced modules
- Aligning payment integrity with procurement strategy
- Partnering with clinical teams on healthcare payment accuracy
- Integrating fraud detection with enterprise risk management
- Sharing intelligence with industry coalitions
- Establishing inter-agency data exchange agreements
- Joint task forces for multi-payer investigations
- Synchronising controls across subsidiaries and divisions
- Creating feedback loops from recovery to prevention
- Standardising definitions across departments
- Breaking down silos between finance and operations
Module 16: Program Evaluation and Maturity Assessment - Assessing your current payment integrity maturity level
- Five-stage model: ad hoc, reactive, defined, managed, optimised
- Gap analysis between current state and best practices
- Benchmarking against peer organisations
- Evaluating return on investment for program activities
- Customer satisfaction with vendor dispute resolution
- Employee adoption rates of integrity protocols
- Reduction in improper payment rates over time
- Improvement in detection-to-recovery cycle times
- Strategic roadmap for advancing maturity
Module 17: Real-World Case Studies and Simulations - Case study: $12M recovery from duplicate Medicaid payments
- Simulation: Responding to a multi-state provider billing scheme
- Case study: Preventing $8M in fraudulent grant disbursements
- Simulation: Investigating a payroll ghost employee ring
- Case study: Reducing ER visit overpayments by 75%
- Simulation: Auditing construction project draw requests
- Case study: Stopping prescription fraud through data linkage
- Simulation: Handling a vendor dispute over overpayment demand
- Case study: Detecting collusion among transportation vendors
- Simulation: Preparing for a federal audit of program integrity
Module 18: Hands-On Project: Build Your Payment Integrity Plan - Step 1: Define your organisational context and scope
- Step 2: Conduct a custom risk assessment
- Step 3: Select detection methods for priority areas
- Step 4: Design recovery workflows and timelines
- Step 5: Draft policy and procedural documentation
- Step 6: Create an implementation timeline
- Step 7: Develop stakeholder communication plan
- Step 8: Build executive dashboard with key metrics
- Step 9: Identify training and change management needs
- Step 10: Finalise and present your complete plan
Module 19: Certification Preparation and Submission - Review of all core payment integrity competencies
- Guidelines for submitting your final project
- Formatting requirements for professional presentation
- Checklist for ensuring completeness and clarity
- Feedback process for iterative improvement
- Scheduling your certification review
- What examiners look for in high-scoring submissions
- Avoiding common mistakes in plan development
- How to demonstrate impact and feasibility
- Final preparation before submission to The Art of Service
Module 20: Beyond Certification - Career Advancement and Industry Recognition - Leveraging your Certificate of Completion for promotions
- Networking with certified peers in the alumni community
- Presenting your work at industry conferences
- Publishing case studies and white papers
- Becoming a subject matter expert in your organisation
- Mentoring junior staff in payment integrity practices
- Contributing to regulatory comment periods
- Joining government advisory panels
- Transitioning into consulting or auditing roles
- Staying current with ongoing updates and advanced modules
- Case study: $12M recovery from duplicate Medicaid payments
- Simulation: Responding to a multi-state provider billing scheme
- Case study: Preventing $8M in fraudulent grant disbursements
- Simulation: Investigating a payroll ghost employee ring
- Case study: Reducing ER visit overpayments by 75%
- Simulation: Auditing construction project draw requests
- Case study: Stopping prescription fraud through data linkage
- Simulation: Handling a vendor dispute over overpayment demand
- Case study: Detecting collusion among transportation vendors
- Simulation: Preparing for a federal audit of program integrity
Module 18: Hands-On Project: Build Your Payment Integrity Plan - Step 1: Define your organisational context and scope
- Step 2: Conduct a custom risk assessment
- Step 3: Select detection methods for priority areas
- Step 4: Design recovery workflows and timelines
- Step 5: Draft policy and procedural documentation
- Step 6: Create an implementation timeline
- Step 7: Develop stakeholder communication plan
- Step 8: Build executive dashboard with key metrics
- Step 9: Identify training and change management needs
- Step 10: Finalise and present your complete plan
Module 19: Certification Preparation and Submission - Review of all core payment integrity competencies
- Guidelines for submitting your final project
- Formatting requirements for professional presentation
- Checklist for ensuring completeness and clarity
- Feedback process for iterative improvement
- Scheduling your certification review
- What examiners look for in high-scoring submissions
- Avoiding common mistakes in plan development
- How to demonstrate impact and feasibility
- Final preparation before submission to The Art of Service
Module 20: Beyond Certification - Career Advancement and Industry Recognition - Leveraging your Certificate of Completion for promotions
- Networking with certified peers in the alumni community
- Presenting your work at industry conferences
- Publishing case studies and white papers
- Becoming a subject matter expert in your organisation
- Mentoring junior staff in payment integrity practices
- Contributing to regulatory comment periods
- Joining government advisory panels
- Transitioning into consulting or auditing roles
- Staying current with ongoing updates and advanced modules
- Review of all core payment integrity competencies
- Guidelines for submitting your final project
- Formatting requirements for professional presentation
- Checklist for ensuring completeness and clarity
- Feedback process for iterative improvement
- Scheduling your certification review
- What examiners look for in high-scoring submissions
- Avoiding common mistakes in plan development
- How to demonstrate impact and feasibility
- Final preparation before submission to The Art of Service