Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

Chapter 2

Defining Market Players within the Primary Healthcare Continuum

Since time is a continuum, the moment is always different, so the music is always different.

–Herbie Hancock

To understand, detect, and then prevent healthcare fraud, it is important to understand the concept of the primary healthcare continuum (P-HCC), which was introduced in Chapter 1. Although the players in the P-HCC do not change significantly, the movement within and among each player is always slightly different, creating the same effect as that described by musician Herbie Hancock. Each fraud scheme generated by the ethically challenged is different, too. The individual, professional, or entity involved reacts to the “music,” or healthcare event, in part using whatever unique experiences, understandings, emotional states, and levels of sophistication are possessed at the time the event is experienced.