Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

Audit Continuum Models Overview: Implications for Prevention, Detection, and Investigation

Dr. Traveler, no doubt, found the devil in the consequences of being “caught” and stopped from perpetuating his scheme. Consequences, in this case, clearly include significant financial damages, of which recuperation began with the seizing of available assets to pay the fines incurred. Dr. Traveler also lost his license and received a criminal conviction under the false claims act, followed by civil lawsuits. Although he tried to return to India, he lost his escape route by acquiring an orange wardrobe via an incarceration sentence. The progression of the Continuum Audit and Investigative model, illustrated again in Exhibit 6.4, highlights the progress in the case study of Dr. Traveler. We have discussed identifying the market players and discovered two more during the process. We incorporated benchmarks, which at times may be as simple as knowing the weather and the basics of typical work week; utilized the information continuum to build a trail; and followed it by measuring damages. Even at this point, it is important to recognize that during the process, it is not unusual to encounter roadblocks. A roadblock may be legislative, contractual, and/or a form of sabotage. Regardless, it is important to recognize that they may occur and, at the least, identify the roadblock by issue. Chapter 7, as noted in Exhibit 6.4, will continue the application of our case study with a review of roadblocks ...