Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

Data Mapping Overview: Implications for Prevention, Detection, and Investigation

This chapter outlines the process for data mapping. Data mapping is the first step toward creating the organization and structure that will set the framework to derive intelligence from data. Healthcare is an industry that processes over a trillion dollars in claim activity annually. Organization and structure are required to successfully sift through large amounts of data and make sense of it all. They create the opportunity to see what everyone else is seeing and to analyze and process what no one else has thought of. The next chapter progresses with the mining of the data that is collected. What we are often told is happening, in reality, may be far from the true story. Data mining takes the audit process to the next level. Data mapping plus data mining provides the tools to challenge what is being presented.