Notary Knowledge by Derrick Spruill

Medical Center Mastery: The Hospital Route Re-entry - Money Making Monday

Derrick Spruill Season 10 Episode 490

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0:00 | 24:16

Ready to turn your local medical facilities into a goldmine? In this episode, Eddie Montes Travis and Marylyn Lee Trotter discuss how to successfully re-enter the hospital circuit to boost your income. We explore why these hubs are essential for any mobile business and how to navigate the unique environment of a healthcare center with ease. • Subject: Building Hospital Relationships. Learn how to establish trust with social workers and medical staff who manage patient documentation. • Subject: Essential Paperwork. Understand the most common medical-related documents like power of attorney and advanced directives. • Subject: Professional Protocol. Tips on maintaining health standards and respecting patient privacy while performing your duties in a clinical setting. • Subject: Maximizing Monday Earnings. Strategic ways to schedule your hospital route to ensure a profitable start to your week. Mastering the hospital route is a proven strategy to grow your client base and increase your weekly revenue. By following these simple steps, you can provide a valuable service to those in need while building a sustainable business. Please subscribe and like the podcast to stay updated on more money-making strategies!

Show Notes:
• Identifying key contacts in medical facilities.
• Managing bedside document signings with care.
• Navigating hospital security and visitation rules.
• Marketing your services to healthcare professionals.

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Executive Producer Derrick Spruill
Writers Marylyn Lee Trotter and Eddie Montes Travis
Graphics & Illustrations by Eddie Montes Travis
Music by Thomas Bynum
This Show is Produced by Magnificent Workz
Business Solutions

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SPEAKER_00

Are you looking for an edge, flexible income, and immediate professional respect? Discover the hidden opportunity of becoming a public official with the book, Becoming a Notary by Derek Sproul. This beginner's guide provides the universal roadmap to launch your new career. You will learn the core mission of deterring fraud, the essential tools of the trade, and exactly how to protect yourself while building a respective business. Get your copy of Becoming a Notary on Amazon and step into a rewarding profession.

SPEAKER_02

Welcome to Notary Knowledge, and today is Moneymaking Monday. So, um, you know, we're getting into strategies for building high-volume referral networks via social workers.

SPEAKER_01

We definitely are. It is a highly requested topic for anyone focusing on healthcare signings.

SPEAKER_02

Right. And today's specific focus is Medical Center Mastery, the hospital route re-entry. But before we really get into the sources, I just want to remind everyone to uh check out the Notary Knowledge books by Derek Spruell.

SPEAKER_01

Yes, absolutely. You can find those and a ton of other resources if you visit the Notary Knowledge website.

SPEAKER_02

And for even more strategies, definitely check out our video podcast, No Notary, with Eddie Montes Travis, as well as Maryland's 90 seconds of notary.

SPEAKER_01

Always good to have those tools in your back pocket.

SPEAKER_02

Exactly. So let's get into today's topic. We are looking at a stack of industry analyses covering, well, everything from hospital access control to federal compliance regulations. And the hook here is just wild to me. $10.92 million.

SPEAKER_01

Yeah, that number is I mean, it's terrifying for a hospital administrator. Trevor Burrus, Jr.

SPEAKER_02

Right. That is the staggering average cost of a single healthcare data breach today. And because of that, um, that specific threat, the friendly handshake at the hospital front door is completely dead.

SPEAKER_01

It really is. Gaining entry to a medical facility right now is no longer about who you know, it is about surviving a boardroom-level risk matrix.

SPEAKER_02

Which is exactly our mission for this show. We want to give you, our listener, the ultimate strategic playbook for navigating modern medical facilities. Because if you want those high-volume referral networks for your business, you have to decode this tri-layered gatekeeper system.

SPEAKER_01

Yeah. And it really is a triad. You are dealing with physical security, digital interoperability, and incredibly strict federal compliance. Missing even one of those layers means you are, well, you're completely locked out.

SPEAKER_02

Regardless of how good your services are.

SPEAKER_01

Exactly. Your outcomes don't matter if you can't get in the building.

SPEAKER_02

Aaron Powell, so I want to start right at the physical entrance because that $10 million threat has turned basic access into what the industry calls a zero trust environment.

SPEAKER_01

Aaron Powell Right. And what is vital to understand here is the underlying mechanism driving that shift. Vendor credentialing used to be this sleepy administrative back office function, you know. Trevor Burrus, Jr.

SPEAKER_02

Like you just fax over a license once a year.

SPEAKER_01

Yeah, exactly. They put it in a filing cabinet and that was it. But today, this strict security paradigm is actually being enforced by cyber insurers.

SPEAKER_02

Wait, the insurance companies are dictating the lobby security?

SPEAKER_01

They are. The insurers underwriting these massive hospitals are demanding that physical access be treated with the exact same zero trust philosophy as network access.

SPEAKER_02

Aaron Powell Meaning the manual paper sign-in sheet is just it's a relic of the past.

SPEAKER_01

Completely gone. It has been replaced by highly sophisticated visitor management systems. You see companies like Securitis and Athena outfitting hospitals with these self-service kiosks.

SPEAKER_02

And these aren't just printing name tags.

SPEAKER_01

Oh no. They feature facial recognition, instant credential verification, and um something called role-based access control or RBAC.

SPEAKER_02

Let's define that for a second. Role-based access control. So if I am a mobile professional doing a specialized signing versus, say, a medical device representative, the physical building literally treats our bodies differently.

SPEAKER_01

Precisely. The system customizes your badge workflows based on your specific role within their database. It ensures you only have physical access to the exact geographic areas you need.

SPEAKER_02

So a device rep's badge might just flash red if they try to walk into a psychiatric ward.

SPEAKER_01

Right. But a visiting specialist badge grants them immediate entry to those same doors.

SPEAKER_02

It feels less like a community hospital and more like a high security data center. I mean, you are authenticated, vetted, and digitally tracked every single step of the way.

SPEAKER_01

You are. And you actually have to do the work before you even arrive on site.

SPEAKER_02

Yeah, the sources mention these pre-registration portals. Like you can't just show up and expect to get credentialed in the lobby anymore.

SPEAKER_01

No, absolutely not. Long before you arrive, you are uploading proof of liability coverage, active state licensures, and uh background screenings.

SPEAKER_02

And proof of compliance training, right?

SPEAKER_01

Yes. Highly specific modules mandated by major accrediting bodies like JCA, the Joint Commission, and DNV.

SPEAKER_02

Just to clarify for the listener, JCA, HO, and DNV are the organizations that essentially give a hospital its license to operate and bill Medicare.

SPEAKER_01

Exactly. If a hospital loses that accreditation, they effectively go out of business. So they push that compliance burden down to you, the vendor.

SPEAKER_02

Wow. So if your bloodborne pathogen certification expired yesterday, the lobby kiosk instantly blocks the physical doors.

SPEAKER_01

It identifies any compliance gap in real time.

SPEAKER_02

But the sources dive to a technical layer here that I found mind-blowing. There is an unseen link between this physical access at the kiosk and the hospital's cybersecurity architecture.

SPEAKER_01

Oh, the DNS architecture.

SPEAKER_02

Yeah, they called it a split traffic DNS architecture. I know DNS acts like the internet's routing system, but how does splitting it actually secure a physical building?

SPEAKER_01

Well, this is where physical security and cybersecurity merge. Um, think of DNS as the digital address book for the hospital's entire network. By using a split traffic architecture, the hospital is essentially maintaining two entirely separate address books. They separate the internal network pathways from the external ones.

SPEAKER_02

So it is like having a public address for the hospital lobby that anyone can find on Google, but the vault holding the patient data uses an unlisted phone number that changes constantly.

SPEAKER_01

That is a perfect analogy. They route traffic over private encrypted connections. So the physical access logs, the data showing who is swiping their badge at which door remain entirely hidden.

SPEAKER_02

Hidden from the outside world.

SPEAKER_01

Right. If hackers are scanning the hospital's network from the outside, they only see the public facing address book. The internal layout, the access control systems, the patient data, they simply do not exist on that public map.

SPEAKER_02

So if hackers don't have the internal routing key, they can't even see the door to the vault, let alone pick the lock.

SPEAKER_01

Exactly.

SPEAKER_02

That is incredible. Okay, so let's say you successfully run this gauntlet, you clear the zero trust front door, your credentials are valid, and you have your customized badge. Now you're physically inside.

SPEAKER_01

Which is only half the battle.

SPEAKER_02

Right, because the next challenge is getting the attention of the human gatekeepers. And the sources paint a picture of an environment that is just boiling over with stress.

SPEAKER_01

The pressure cooker environment. Once you are inside, you have to engage with the discharge planners and hospital social workers.

SPEAKER_02

And to understand their reality, you really have to understand the systemic financial stress they operate under, primarily due to the Medicare inpatient perspective payment system.

SPEAKER_01

The IPPS, yes.

SPEAKER_02

I read through the mechanics of this, and it sounds like a brutal paradox. It fundamentally changes how hospitals make money, doesn't it?

SPEAKER_01

It does. Under the IPPS, Medicare pays hospitals a flat, predetermined rate based on the patient's diagnosis. It's called their diagnosis-related group or DRG.

SPEAKER_02

Okay, so it's a flat rate.

SPEAKER_01

Right. It doesn't matter if the patient stays in the hospital for three days or 13 days, the hospital gets the exact same amount of money.

SPEAKER_02

Meaning every additional day a patient stays in the bed, the hospital is actively losing money on them.

SPEAKER_01

Exactly. So the social workers are evaluated on keeping the average length of stay the LOS as short as possible. The hospital desperately wants beds cleared to bring in new patients.

SPEAKER_02

But here's the paradox, right? The hospital faces massive financial penalties from Medicare if those same patients are readmitted within 30 days.

SPEAKER_01

It's an intense dual pressure. They are caught between institutional throughput goals, moving people out quickly, and the clinical imperative to ensure patient safety so they don't bounce right back to the ER.

SPEAKER_02

This is what leads to that terrifying phenomenon the sources mentioned, where patients are discharged quicker and sicker.

SPEAKER_01

Yeah, often into homes that are completely ill-equipped for their recovery.

SPEAKER_02

You know, this reminds me of Keisha in Alabama. Like Keisha was telling us, she had a real gut feeling during assigning at a nursing home that a patient had just been rushed out way too fast.

SPEAKER_01

Well, that's exactly the reality these social workers are facing. And add administrative chaos to that emotional burden. A frontline social worker is spending hours making manual phone calls, dealing with fax machines that literally jam because patient files are hundreds of pages long.

SPEAKER_02

Just trying to find a post-acute provider who has an open bed.

SPEAKER_01

Right, or someone who accepts the patient's specific insurance.

SPEAKER_02

Which raises the central question for anyone trying to partner with these facilities. How do you actually cut through that noise? How do you prove your value to a social worker who is practically drowning in rapid discharge quotas?

SPEAKER_01

You do it by leading with hard data, not promotional brochures. A social worker doesn't have the time or the bandwidth for a generic sales pitch.

SPEAKER_02

They need a solution, not a flyer.

SPEAKER_01

Exactly. If a mobile provider walks in and presents audited 30-day readmission rates, rapid referral response times, and a proven ability to handle complex social drivers of health like food or housing insecurity, they instantly transform from a nuisance vendor into a strategic solution.

SPEAKER_02

Because you suddenly become the answer to their institutional targets. You are the tool that lowers the length of stay without triggering the readmission penalty.

SPEAKER_01

Precisely. And successful mobile providers are expanding this strategy beyond just social workers. They are aligning with palliative care directors and patient advocates.

SPEAKER_02

Which is a huge area for advanced care planning.

SPEAKER_01

It is. For a palliative care director, you focus your data on advanced symptom management. You demonstrate how your team bridges the gap between the acute hospital and the patient's home, ensuring that documented wishes, like do not resuscitate orders, are respected outside the hospital.

SPEAKER_02

You are basically taking the burden of complex out-of-hospital care off their shoulders. So you've handed the social worker and the palliative director your data, and they are thrilled they want to give you the referral. But the sources highlight a crazy reality here. None of that human goodwill matters if the hospital software literally prevents them from finding your name.

SPEAKER_01

This is where we transition from human relationships to the invisible digital pathways of modern healthcare. Having the right data is useless if you are invisible in the software systems they use to actually route the patients.

SPEAKER_02

Because when a social worker initiates a discharge today, they are not reaching for a physical Rolodex.

SPEAKER_01

No, they are leveraging transition of care software platforms like Careport, CureSpan, and Aiden.

SPEAKER_02

And these aren't just standalone apps on an iPad. They are deeply integrated directly into the hospital's massive electronic health record systems like Epic and Sleener.

SPEAKER_01

Natively embedded, Careport alone manages a national database of over 110,000 Post-acute providers. Wow. Yeah. If you are a mobile professional and you have not proactively registered your business in these specific registries, with your clinical competencies verified, you are literally invisible to the discharging clinician.

SPEAKER_02

The software simply will not populate your name as an option when they search.

SPEAKER_01

It won't. They couldn't send you a patient even if they personally wanted to.

SPEAKER_02

That blew my mind when I read it. And this interoperability is being forced from the top down by the government, isn't it?

SPEAKER_01

It is. The Centers for Medicare and Medicaid services implemented conditions of participation that mandate real-time event notifications.

SPEAKER_02

The ADT feeds.

SPEAKER_01

Right. Admission, discharge, transfer. At the exact moment a patient is admitted or discharged, the hospital system automatically fires off encrypted notifications to the patient's primary care physician and their designated PostAcube partners.

SPEAKER_02

Which requires everyone to speak the exact same digital language. This kind of reminds me of Carl in Nevada. He was dealing with vital records, and it's a similar concept. If you aren't in the right digital pipeline, the paperwork just stops. The sources kept mentioning the C CDA. What actually is that?

SPEAKER_01

The C CDA stands for the Continuity of Care Document. It is a standardized electronic markup language for clinical data.

SPEAKER_02

So it's basically the universal translator for healthcare data.

SPEAKER_01

Basically, yeah. It ensures that when a hospital's EPIC system sends an allergy list or a medication history, your mobile provider software knows exactly what to do with that data and places it in the correct fields automatically.

SPEAKER_02

And the most aggressive providers are using all this data to capture referrals before their competitors even know the patient is sick.

SPEAKER_01

Oh, absolutely. They are using specialized healthcare customer relationship management platforms or CRMs like Trella Health.

SPEAKER_02

The sources noted Trella analyzes over 1.7 billion medical claims annually.

SPEAKER_01

Think about the power of that algorithm. By analyzing that many claims, a mobile provider can precisely target Medicare Advantage referral sources.

SPEAKER_02

So they can walk into a hospital and say, our data shows your COPD patients are readmitting at a 15% higher rate than the county average, our specific clinical pathway lowers that to 5%.

SPEAKER_01

Exactly. They are benchmarking their own readmission rates against their competitors in real time.

SPEAKER_02

I have to push back on this a little bit though. I mean, if everything is being automated through these massive algorithms, integrated EHRs, and real-time ADT data feeds, doesn't that completely eliminate the need for human trust? Are we just moving data packets around based on API handshakes?

SPEAKER_01

It is a valid concern. Um, but the reality on the ground is that technology does not replace the human relationship. It validates it.

SPEAKER_02

How so?

SPEAKER_01

Well, a hospital social worker might know you, like you, and trust you implicitly based on years of past interactions. But if your electronic profile isn't properly integrated to accept that CCDA instantly and securely, their institutional compliance protocols will physically prevent them from routing that patient to you.

SPEAKER_02

So the software is the tracks, but the relationship is the engine.

SPEAKER_01

Exactly. If you don't have the tracks laid down, the engine can't go anywhere.

SPEAKER_02

I love that analogy. All right, we need to take a quick commercial break, but when we come back, we are going to navigate the legal minefield of healthcare partnerships.

SPEAKER_01

You won't want to miss it.

SPEAKER_02

And we are back. So we've got the physical badge, we've navigated the pressure cooker to build relationships with the social workers, and the software is officially routing patients to our CRM.

SPEAKER_01

Sounds like a perfect setup.

SPEAKER_02

It does. We are officially making money, but the sources point out a terrifying reality. The way you structure the finances of this new partnership could accidentally trigger a federal investigation.

SPEAKER_01

Yeah, we have definitely entered the legal minefield. The stakes here are existential for any business.

SPEAKER_02

We are primarily looking at two massive federal frameworks designed to prevent fraud and abuse. The physician self-referral law, commonly known as the Stark Law, and the Federal Anti-Kickback Statute, or AKS.

SPEAKER_01

Aaron Powell, let's start with the Stark Law.

SPEAKER_02

I'm looking at the notes on this, and it says it is a strict liability statute. Does that mean what I think it means? Like if a provider makes an honest accounting mistake, they are still a federal criminal.

SPEAKER_01

Strict liability means intent does not matter. If you accidentally violate the Stark law, meaning you refer a Medicare or Medicaid patient to an entity where you have a financial interest, and it doesn't fit into a predefined legal exception, you are guilty. Full stop.

SPEAKER_02

Wow. And the penalties.

SPEAKER_01

An accidental violation still results in massive penalties, up to $15,000 in fines per individual service plus treble damages. Aaron Ross Powell, Jr.

SPEAKER_02

Treble damages, meaning paying back three times the amount of the original claim.

SPEAKER_01

Yes.

SPEAKER_02

It's like playing a high-stakes board game where breaking a rule you didn't even know existed bankrupts your entire company instantly.

SPEAKER_01

It really is. But the AKS, the anti-kickback statute, that one functions a bit differently.

SPEAKER_02

Aaron Powell Right, because the AKS focuses on intent, doesn't it?

SPEAKER_01

It does. It prohibits knowingly and willfully paying or receiving remuneration, which means anything of value, cash, or in kind to induce referrals.

SPEAKER_02

But here is the critical shift the sources highlight. The government recognizes that these legacy laws were built for an outdated fee-for-service world.

SPEAKER_01

Right, where incentivizing volume was the core problem. Now the entire industry is moving toward value-based care.

SPEAKER_02

To continue my board game analogy, the government essentially released an expansion pact to make the rules fit the modern game.

SPEAKER_01

Exactly. They introduced value-based exceptions or VDEs to the Stark law and corresponding safe harbors for the AKS.

SPEAKER_02

And these frameworks are designed to actually reward providers for collaborating and improving outcomes, right? Without the constant fear of crushing federal penalties.

SPEAKER_01

Yes. The sources lay out three distinct tiers for these value-based exceptions, based entirely on how much risk the providers are willing to take on themselves.

SPEAKER_02

Let's break those down.

SPEAKER_01

The highest tier is full financial risk. In this model, the provider is financially responsible for the entire cost of care for a target patient population. If the care costs more than the fixed budget, the provider eats the loss.

SPEAKER_02

That sounds incredibly risky.

SPEAKER_01

It is. Then there is meaningful downside risk, where the provider is on a hook to repay a significant percentage like 10% under STARK or 5% under AKS if they fail to meet specific quality or cost targets.

SPEAKER_02

And the third tier.

SPEAKER_01

Care coordination arrangements, which requires no downside financial risk at all.

SPEAKER_02

Now, this seems like the absolute sweet spot for a mobile professional who wants to integrate closely with a hospital, but simply does not have the capital to take on massive financial liability.

SPEAKER_01

It absolutely is a sweet spot, but you still have to be incredibly careful about how you provide value to the hospital. You can't just buy their favor.

SPEAKER_02

Right, which makes me think of Patty in DC doing guardianship petitions or Fiona in Idaho reporting suspected elder abuse during a signing. When you are dealing with sensitive high-stakes referrals, the compliance has to be airtight. You can't be bribing people for access.

SPEAKER_01

A perfect example in the sources is a recent advisory opinion from the Office of Inspector General, OIG Advisory Opinion 2214. It dealt specifically with continuing education events.

SPEAKER_02

I read this part. So if a mobile provider wants to host a continuing education lunch for hospital staff to build relationships, the OIG outlined incredibly strict rules to ensure that lunch isn't viewed as an illegal kickback.

SPEAKER_01

The rules are absolute. Attendees must be charged fair market value fees to attend the education. The content must be objectively educational and accredited, not a veiled sales pitch.

SPEAKER_02

And the food.

SPEAKER_01

It must be strictly modest. The OIG specify limits of $15 to $20 per person, and absolutely no alcohol can be served.

SPEAKER_02

And you can't selectively invite attendees based on their past referral volume, right? Correct. So a $15 sandwich, a bottle of water, and accredited learning. If you offer a steak and a glass of wine to your top referration, you have just crossed into a federal crime.

SPEAKER_01

Which brings us to the ultimate synthesis of all these sources. How do you combine the physical access, the digital integration, and the legal compliance into a winning strategy?

SPEAKER_02

You do it through something called a risk-adjusted alignment score.

SPEAKER_01

Yes. Imagine walking into a hospital boardroom. You don't hand them a glossy brochure about how much you care about patients. Instead, you provide a quantitative formula.

SPEAKER_02

You prove to the hospital exactly how your service lowers their total cost of care, reduces their specific discharge delays, and helps them meet incoming regulatory burdens.

SPEAKER_01

You say our CRM is SOC2 type 2 certified, we execute full business associate agreements, our care port integration is live, and our care coordination arrangement fits perfectly into a Stark Law value-based exception.

SPEAKER_02

Wait, for the listener who isn't a compliance officer, let's translate that. When you tell a hospital board you are executing a full business associate agreement or BAA, what is actually happening legally?

SPEAKER_01

A BAA is a legally binding contract mandated by HIPAA. By signing it, you as the vendor are essentially putting your own neck on the line.

SPEAKER_02

You are accepting direct federal liability.

SPEAKER_01

Exactly. You are telling the hospital if this data breaches, the government can come after us, not just you.

SPEAKER_02

And you pair that with the SOC2 type 2 certification. What does that prove to the board?

SPEAKER_01

Well, SOC2 Type 2 is an incredibly rigorous third-party cybersecurity audit. But unlike a type I audit, which just checks if you have security rules on a single day, a type 2 audit takes place over many months.

SPEAKER_02

So it proves to the hospital that you actually follow your own security protocols every single day.

SPEAKER_01

Yes. You are walking in and saying, we legally share your liability, we have third-party proof that our cybersecurity is impenetrable, our software speaks natively to your epic system, and our financial model is federally combined.

SPEAKER_02

You aren't just a partner, you are solving their entire risk matrix.

SPEAKER_01

You are offering them a mathematically proven safe harbor in a very dangerous ecosystem.

SPEAKER_02

Which brings us to the core takeaway of this show. To survive and thrive in the post-2025 healthcare ecosystem, you cannot just be good at your job.

SPEAKER_01

Being great at what you do is just the baseline expectation.

SPEAKER_02

Right. To actually get access to the building and secure those high-volume referrals, you must master this triad of competencies. Clearing that zero trust physical security with flawless credentialing, deeply integrating your software into transition platforms, and strictly adhering to federal fraud and abuse frameworks.

SPEAKER_01

It is the definitive blueprint for how modern healthcare partnerships are forged and maintained.

SPEAKER_02

And it matters to all of us, whether you are an administrator, a mobile professional trying to build a sustainable business, or simply a patient trying to understand why your care transitions happen the way they do. Understanding this invisible machinery is crucial.

SPEAKER_01

Because the invisible machinery is running the show, evaluating risk at every single touch point.

SPEAKER_02

And speaking of that machinery evaluating risk, I want to leave you, our listener, with a final provocative thought based on the sources we reviewed.

SPEAKER_01

Oh, about the predictive AI.

SPEAKER_02

Yeah, we talked a lot about the incoming wave of regulations and the massive use of predictive AI in clinical decision tools. As algorithms get better and better at analyzing billions of claims to predict exactly which post-acute provider will prevent a readmission for a highly specific patient profile? Will the next generation of referral networks remove human choice from the hospital discharge process entirely?

SPEAKER_01

It really is the logical conclusion. I mean, if the AI knows with mass medical certainty exactly which provider will keep the patient healthiest and save the hospital the most money, will the social worker or even the patient have a say in the matter?

SPEAKER_02

Something for you to mull over. Because while the friendly handshake might be dead, the algorithms are just waking up. Remember, email your questions to Derek at derekspruell.com. We will try to answer as soon as possible at the end of our shows.

SPEAKER_01

Music Thomas Bynum. Produced by Magnificent Works Business Solutions.

SPEAKER_02

Don't just be listeners of the knowledge, be doers of the knowledge. This is notary knowledge. Until next time.

SPEAKER_00

Are you looking for an edge, flexible income, and immediate professional respect? Discover the hidden opportunity of becoming a public official with the book, Becoming a Notary by Derek School. This beginner's guide provides the universal roadmap to launch your new career. You will learn the core mission of deterring fraud, the essential tools of the trade, and exactly how to protect yourself while building a respective business. Get your copy of Becoming a Notary on Amazon, and step into a rewarding profession.