Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

Operational Flow Activity Assessment

What exactly is an OFA? Operational flow is the identification and flowcharting of the actual business components. By comparison, HIPs identify the sources and uses of health information. The ARPs identify the monetary implications of the sources and uses of health information. OFAs identify the procedural aspects associated with HIPs and ARPs.

The auditor’s checklist includes tracing the operational procedures associated within each market player and creating a process flowchart. At each identified operational function, the following should be identified:

Internal communications

External communications

Critical communication component

• Electronic/technology platforms
• Paper
• Verbal
• Facsimile
• People and entities (business, philanthropic, social, political, governmental)
• Systems/vendor relationships
• Product or service output
• Social media
• Intranet, extranet, Internet

The Patient

Exhibit 12.1 demonstrates the application of the OFA concept and integrates it into the previous discussion of the patient’s HIPs and ARPs. Note the following flow of audit/investigation preparation:

HIP = identification of health information

ARP = identification ...