Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

The Secondary Healthcare Continuum (S-HCC)

S-HCC Definition

The second level of analysis is based on the secondary healthcare continuum (S-HCC). S-HCC analysis identifies each entity that uses information generated from the P-HCC for data intelligence. For example, compliance auditors require information generated to ensure that appropriate internal controls exist. Another example lies in public health, when statistical information regarding certain outbreaks of infection or issues that compromise the health and safety of the public is collected and reported.

Within the context of an audit and or investigation, this category also serves as a resource to select appropriate market information for benchmarking. For example, www.cdc.gov (Centers for Disease Control and Prevention) is a great resource for data on occurrence of diseases. Specific, relevant data can be utilized to benchmark a particular audit. While working on a “rent-a-patient” employer benefit plan scheme, the clinic in question had a patient population in which 70 percent of their patients were diagnosed with sweaty palm disease. The condition is referred to as hyperhidrosis and occurs in about 2.8 percent of the U.S. population.2 A clinic may specialize in a particular disease process and, statistically, it may explain a variance. However, when the clinic submits a number of claims from just one geographic location that is higher in volume than the occurrence of a disease among the entire U.S. population, this, in ...