Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

Micromanagement Perspective

My personal goal in writing this guidebook is to provide tools that will move with the market. The key is to identify the truth. As ancient Roman historian Livy notes, “The truth is often eclipsed but never extinguished.” This audit guidebook is about seeing the truth among a set of events. In preparing for the final chapters of the first edition this book and pulling myself out of the box of details that went into writing it, I sent out a simple survey question: “If, from your experience, you could pick one thing wrong (a gut response) with the healthcare system, regardless whether as a professional, patient, employee, employer, or observer, what would that be?” A variety of individuals received this question, including stay-at-home parents, lawyers, accountants, programmers, auditors, writers, researchers, and healthcare professionals. View their statements as symptoms of the problems discussed throughout this book. I repeated this survey with the second edition. The following is a listing of responses from the original edition of this book followed by the current edition. The 2010 Affordable Care Act no doubt has increased the depth of the discussions, however, the theme of concerns appear to be the same. Their responses, which define fragmentation, segmentation, and market conflicts, speak for themselves.

Survey Responses

As a Healthcare Professional/Employee/Observer:

“Oh, and in addition to the compensation issue by payers driving down doctor ...