| The purpose of the current study was to provide public healthcare programs with recommendations implementing an Enterprise Risk Management (ERM) strategy. In 2016, the U.S. government made the legislative decision to move towards risk-based management using the Fraud Risk Management Framework. However, the change process is still within the infancy stage, leaving program leaders with minimal guidance to implement such changes. The current study conducted a risk identification, risk assessment, and Root Cause Analysis (RCA) to identify which fraud risks pose the greatest threat to public health programs and possible reasons why the threat exists. It was found that kickback schemes in combination with billing for medically unnecessary services pose the greatest threat to public health programs. It was concluded this combination is a significant threat because it allows fraudsters to evade detection, schemes are financially lucrative, and rewards outweigh risks. Several weaknesses in current risk management strategy were identified. Based on these weaknesses it was recommended public health programs empower employee's ability to combat fraud by eliminating barriers to success, recognize beneficiaries as key stakeholders in the solution, prioritize risk assessments, establish proper performance measurements that enable organizational learning. |
