Continuum Audit Progression—Recap

Primary Healthcare Continuum—the market players

  • Professional service by licensed MD; senior citizen complex and private nursing homes; Medicare, Medicaid, and private payers.

Secondary Healthcare Continuum—market benchmarks

  • Public policy on health screenings; reimbursement rules, guidelines, and standards on home health visits; diagnosis and procedure code standards; weather history; geography and travel times; credentialing and licensure verification of all providers; privacy breaches during free screening offerings; self-dealing potential Stark Violations during onsite visits with the senior residences. Data analytics would include several hypotheses, with the ultimate question being, “Did the doctor violate the false claims act, in addition to participating in other adverse behaviors?”

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