Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

Chapter 15

Normal Infrastructure

Greed is a fat demon with a small mouth, and whatever you feed it is never enough.

–Janwillem van de Wetering (1931–2008)

The preceding chapters discuss, in detail, members of the primary healthcare continuum (P-HCC). The pipelines for the patient, the provider, the payer, the plan sponsor/employer, and the vendor/supplier outline the general framework of the various organizations and key operational features in the execution of each player’s business functions. Understanding the normal infrastructure of each market player allows the opportunity to begin both an audit or investigation and the respective collection of data within each setting. An essential component to the collection process is the interview of the individuals within these settings. Remember that these infrastructures are driven by the people who work within them and lead them. A healthcare audit and detection guidebook could not go without a discussion on the people behind the process and those who are prone to the “fat demon” of greed.