Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

Clinical Content Analysis Overview: Implications for Prevention, Detection, and Investigation

The SOAP methodology tool analyzes clinical record content, including the exact words used and their meanings. The tool can be applied to content that is generated by handwritten notes or electronically generated reports. Some auditors and investigators have expressed concern that opportunities for detection will be lost in the electronic world. This could not be further from the truth.

Electronic content, if anything, creates a greater number of opportunities for detection because auditors can use data-mining techniques in their examination of it. In addition, the audit logs within a computer system, such as those tracking users and the electronic architecture of the computer systems, create opportunities for tracking user behavior that did not exist before. A simple example is the notation of time. Between 60 and 80 percent of handwritten records make no notation of time. The understanding of when an actual event occurred is golden. Computer-generated records are formatted to record the time of entry regardless of whether the author remembers to do so. Finally, the methodology of SOAP and its ability to quantify qualitative data provide EDA opportunities to understand and prove intent.

The narrative discourse analysis provides an in-depth tool to analyze any statements of an individual to ascertain the substance behind spoken or written words. What are the true thoughts being communicated—directly ...