New DeKaye Article Identifies “Hierarchy of Greed” in Healthcare Fraud

July 22, 2009 - PRLog -- New DeKaye Article Identifies “Hierarchy of Greed” in Healthcare Fraud
“Inside Criminal Minds” focuses on detection, prevention, and training

Oceanside, NY (July 21, 2009):  Allan P. DeKaye, MBA, FHFMA, President and CEO, DEKAYE Consulting, Inc., announced the publication of his newest article, Inside Criminal Minds.  The two-part article appears in the June 30, 2009 and July 14, 2009 issues of Commerce Clearing House’s (CCH) Health Care Compliance Letter (Vol. 12-13 and 12-14).  Mr. DeKaye serves on the publication’s editorial advisory board.  After several months of research and interviews, he developed a classification pyramid to categorize the five levels of greed that seem most prevalent in healthcare fraud and abuse.  The article examines behavioral characteristics and tendencies ranging from front-line staff to those in the C-Suite, while explaining how not-for-profits can be as vulnerable as for profit organizations.

“It’s been 16 years since then U.S. Attorney General Janet Reno declared war on healthcare fraud,” DeKaye noted, “And we are still fighting this battle.”  He premised his article on identifying the reasons why and how “bad actors” do the things they do.  Drawing on the work of behaviorist Abraham Maslow’s “hierarchy of need,” DeKaye patterned his “Hierarchy of Greed” in a pyramid.  He defined five levels of greed:  undisciplined, opportunistic, corporate, scheme and organized.

The article goes on to describe examples of the five levels of greed, and provides illustrations of each type.   He notes that “undisciplined greed” includes celebrity data breach, while “opportunistic greed” finds individuals selling protected health information for profit.  In this context, he goes on to further explain and differentiate between financial and medical identity theft, and how this problem needs to be addressed.   In “corporate greed,” the article explores how ego may be a precursor to committing fraudulent activities, the concept of “misguided altruism” or making the organization the best at any cost, and “loophole exploitation” or pushing the envelop in areas like cost-reporting or entering risking contracts places healthcare organizations in the crosshairs of federal and state prosecutors.

In “scheme greed,” DeKaye goes on to provide examples of how individuals and even families exploit the thinly protected Medicare and Medicaid programs from theft of individual and provider identification numbers to facilitate generating false claims.  He also describes how these schemes operate as they move from one geographic area to another to avoid being detected.  Ethnicity and barriers to employment entry are also presented as contributing factors to this type of greed. The entry of organized crime into healthcare is portrayed as criminal enterprises seeking out lower penalties than drug-trafficking and other crimes to capitalize on schemes and other weak points in the trust based Medicare and Medicaid programs.

While painting these various portraits of the criminal mind, DeKaye does explore the enhanced role that health care boards of trustees are beginning to play in order to reduce an organization’s vulnerability.  He also indicates that the same type of data-mining used by federal and state agencies to target fraud could also be employed by providers to build their own internal data defense systems of protection.  He also describes the types of screening that should be considered when hiring new employees.

DeKaye called upon colleagues from the legal, accounting and human resources arenas to offer additional perspectives on how healthcare providers can protect themselves from the internal and external assault of fraud, abuse and waste.  He also provides insight from the prosecutorial perspective as law enforcement nationwide ratchets up the HEAT (new national task force) on fraud detection, investigation and prosecution.

The two-part article can be downloaded from DeKaye’s home page at his web site (www.dekaye.com), where he has also posted the topics and learning objectives of two new seminars (Inside Criminal Minds and Preventing Identity Theft at Your Hospital) that can be presented at your organization.

About DEKAYE Consulting, Inc.
Allan P. DeKaye, MBA, FHFMA, has over 35 years of experience in the healthcare field.  He is President and CEO of DEKAYE Consulting, Inc., a national firm specializing in Accounts Receivables Management and Medical Records Coding.  Mr. DeKaye has an MBA in Healthcare Administration from Baruch College of the City University of New York.  He has taught at the graduate level, and currently serves on the editorial advisory boards of several industry publications.  He is a Fellow in HFMA, and has received several of their merit awards, including its Medal of Honor.  He also holds membership in the American Collectors International organization.

Mr. DeKaye is a recognized industry leader in revenue cycle management.  He is author/editor of the well-respected text, The Patient Accounts Management Handbook.  He has also authored many articles which have appeared in various industry publications.  He is also the creator of PFS Power Rankings(sm), a national benchmarking system for hospital Patient Financial Services (PFS) departments.  Mr. DeKaye's Emphasis on Education(sm) and related programs have been attended by over 6,000 participants, and he is a frequent speaker at national, regional and local trade association conferences.  DEKAYE Consulting, Inc., also maintains strategic alliances with data, decision support and technology companies.

For more information contact: DEKAYE Consulting, Inc. call (516) 678-2754, write: dkconsult1@aol.com, or visit www.dekaye.com

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DEKAYE Consulting, Inc., a national healthcare consulting firm specializing in Accounts Receivables Management and Medical Records Coding, is a recognized leader in healthcare revenue cycle management, staff training and education.