Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

Market Understanding

Strategic Thinking

Strategic thinking is critical in managing health information in a fragmented market with multiple goals, objectives, and conflicting incentives for profit. Managing risk involves employing effective strategies to enhance the ability to integrate fragmented, distorted information; discernment of realities; and multiple perspectives. Managing risk should also incorporate understanding illicit and licit business diversification, functions, and their respective entities. Utilizing market understanding and analytic methodology is outlined below through a strategic, sophisticated, and comprehensive infrastructure audit system.

System Infrastructure Audit

This book reflects the audit model utilized by Medical Business Associates, Inc. (www.mbaaudit.com), referred to as the “MBA Continuum Audit & Investigative Model,” to implement an effective audit and investigative program. The six conceptual levels of audit and investigative analysis aim to define and evaluate all the entities and activities involved in a healthcare transaction. They address “health information” and respective “monetary” impact.