Medical audit under the sentinel effect

Medical audit under the sentinel effect Conference

Bouayad, L, Padmanabhan, B, Chari, K. (2013). Medical audit under the sentinel effect .

Current practices for auditing fraudulent providers in healthcare are based on scoring models used to select providers or claims that are likely fraudulent. These models ignore the sentinel effect. This is the idea that in addition to the direct benefits of auditing fraudulent providers, there is a second order benefit that arises from behavior modification of other providers who become aware of the audit. In this paper we present an algorithm, agent-based simulation and analytical results that illustrate the significant economic benefits that might be gained if healthcare auditing algorithms take this sentinel effect into account. © Thirty Fourth International Conference on Information Systems, Milan 2013.