More Auditing Is Needed In Today's Medical Practice!
By: Ashley Newsome, CPC, CPMA
August 16, 2018

Medical chart audits have long been performed by government entities and payers for a variety of reasons on many levels.  Why are provider
offices and medical groups, large and small, not focusing more on internal auditing?  

Those in the health care field have long known about the risk of audits and investigations.  An audit does not necessarily mean an error or
crime has been committed but is a check and balance of what was documented and provided to the patient versus what was billed to insurance
company or entity.

Audits through the years have taken on a negative presence in the healthcare industry instead of boosting a positive culture of compliance
within an organization.  It is no secret that fines and penalties are overwhelming when they are levied or a settlement is reached.  

At the time this article is being written, within the past 48 hours, the OIG has issued three notifications of the latest enforcement actions:
Durable medical equipment provider Lincare pays $5.25 million to resolve false claims act allegations (08/16/2018)
Genessee County physician and two others charged with health care fraud (08/16/2018)
Post Acute Medical agrees to pay more than $13 million to settle allegations of kickbacks and improper physician relationships

Auditing is a valuable tool to ensure not only for
coding and billing compliance, but also that administrative functions are performed properly
and timely and that financial relationships are not improper or resulting in a Stark violation or anti-kickback.

Every office can’t employee a dedicated auditor and/or a compliance officer per se’. However it is not unreasonable to employ those trained in
auditing and/or compliance to assist with auditing and monitoring standards within the organization to ensure compliance, minimize risk, and
quickly identify and resolve any issues discovered.

Certification is an option, but not a requirement.  The minimum expectation should be to have trained personnel within the organization to
complete an internal audit however external auditors may be used to ensure efficiency, effectiveness and accuracy of the overall program
internally. Education and training can be costly and maybe the training budget is nearly empty as we approach the second half of the year, but
it won’t be more costly than recoupment and/or fines and penalties as the result of negative audit or investigation.