Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

The Secondary Healthcare Continuum (S-HCC)

S-HCC Application

The S-HCC, as discussed in the prior chapter, is about obtaining the relevant authoritative benchmarking references. Based on the information presented in the case study, the following is an outline of information and standards that should be considered. Exhibit 4.1 provides a graphic summary of this continuum.

Exhibit 4.1 Secondary Healthcare Continuum (S-HCC)

Source: Medical Business Associates, Inc. (www.mbaaudit.com)

• Public Policy—Health promotion has its public policy history on wellness and health dating back to 1984, when The World Health Organization declared health promotion to be “the process of enabling people to increase control over, and to improve, their health.”1 Since 1984, the public policy debate has been very active, extensive, and, at times, volatile. This is especially true when involving major legislative changes, such as those associated with The Affordable Care Act that was passed by Congress and signed into law by President Obama in March 2010. One debate is with the very nature of healthcare in and of itself: “Is access to health a right or a privilege?” This issue is not a central focus of this case study; however, the notion of a patient’s right to receive, at minimum, healthcare screenings, should be remotely kept on the radar for consideration with respect to how providers “donate” their ...