Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

The Primary Healthcare Continuum: An Overview

The primary healthcare continuum (P-HCC) is shown in Exhibit 1.5 as a diagram representing entities that can and will most likely impact an episode of care. The chapters that follow break down the components of this diagram, offer new continuum models, and introduce new terms. The P-HCC includes health information pipelines (HIPs) for each market player. In addition, this book will guide you through the monetary transactions referred to as accounts receivable pipelines (ARPs), which are monetary transactions as well as audit trails of protected health information (PHI). In the P-HCC model, money is viewed as equivalent to PHI. Note in Exhibit 1.5 that each entity has PHI generated or processed. At each transfer point, money is generated or processed at the same time. Exhibit 1.5 shows organized crime as a disconnected illegitimate third party. It is given its own designation as an entity because of the growing number of complex organized crime schemes integrated into the normal flow of business.

Exhibit 1.5 Primary Healthcare Continuum (P-HCC)

Source: Medical Business Associates, Inc. (www.mbaaudit.com).