Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

The Information Healthcare Continuum (I-HCC)

I-HCC Case Application

As discussed originally in Chapter 3, the information continuum is simply about the operational systems, which contain the information utilized by the identified parties. The focus is to understand the sources of data, how that data is housed and stored, and what information is received and/or maintained by any third parties. Dr. Traveler has a 1,800-square-foot urban setting office with one front area office and a rear door exit. He has two receptionists, one nursing unlicensed assistant and one physician assistant, also unlicensed. Please keep in mind that you must always clarify the term physician assistant (medical assistant). An actual PA is a licensed professional with the appropriate education and license to practice. Some clinics will use the term physician assistant although the individual is equivalent to a medical assistant or nurses’ aide, neither of which requires a formal education. A review of Exhibit 5.1 highlights the key components.

Exhibit 5.1 Information Healthcare Continuum (I-HCC)

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

Data Input Considerations

• The receptionist schedules appointments into the billing system, in addition to adding them to a hard-copy desk calendar. The office utilizes a hard-copy receipt system for confirmation of future appointments and documentation ...