Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

Chapter 5

Information Healthcare Continuum

I’ve got volumes on how not to behave. I’ve got more information now than a guy should have at my age.

–Charlie Sheen

Lying, cheating, and stealing are as old as time. If you look at history, the evolution of what is noted as “waste” leads toward recognizing a particular behavior as “abuse;” that behavior will eventually be labeled as “fraudulent” activity. There is no doubt that many market rules can be confusing, leading to misinterpretation and so forth; however, the simple notion of “do not take what does not belong to you” or “do not submit a claim for a service you did not do” is abundantly clear. I am confident that all market players feel as if they have more information than they can handle. The need to stay on top of the latest set of rules has developed a cottage industry for consultants to help filter all the rules and stay on top of changes in the rules. That aside, in this chapter we progress in our case study from the previous chapter by highlighting the attributes of “information” that should be considered with Dr. Traveler.