HCPro.com: Healthcare Auditing Weekly

This weekly email newsletter offers health care internal auditors and compliance professionals the latest information on setting up and maintaining an effective auditing program.

March 4, 2008 (Volume 6, Issue 8)

RACs discover $371 million in improper Medicare payments
Recovery Audit Contractors (RACs) uncovered more than $371 million in allegedly improper Medicare payments in 2007, according to a CMS report.

Members of Congress request GAO study on RACs program
Four congressmen and one congresswoman are asking the Government Accountability Office (GAO) to conduct a study on the private Medicare Recovery Audit Contractor Program.

Tip: How to attack risks
Develop your risk-assessment processes based on your organization’s size and needs. Consider these eight strategies as you both assess your organization’s internal controls and identify risks.

DOJ nabs 245 defendants in Florida for Medicare fraud in FY2008
Florida continues to be a hotbed for Medicare fraud. The U.S. Department of Justice (DOJ) announced September 30 that it charged 245 Florida defendants in fiscal year 2008, for a total of $793,448,162 in fraudulent payments.

Colorado could owe Medicaid $481,000
The Colorado Department of Health Care Policy and Financing might owe the federal government as much as $481,000 for reimbursement claims submitted in fiscal years 2003 and 2004, an OIG audit found.

Insufficient data sharing leads to overpayments by Kansas, Missouri
Lack of inter-government dialogue cost the states of Kansas and Missouri some $196,000 total in erroneous Medicaid payments, according to two recent OIG audits.

Follow-up audits find more problems in Missouri, none in Oklahoma
A follow-up audit of the Missouri Medicaid agency found the agency had not covered all the weaknesses identified in a previous OIG audit.

Featured Audit Plan: OIG Supplemental Compliance Program Guidance for Hospitals audit
Looking for a particular audit plan that may help make your job easier? Turn to the "Audit Plans" section of the Healthcare Audit Resource Center, the home of dozens of audit plans designed to help any auditor out of a jam.

Survey
Could you use a book filled with tips and strategies to help you make the "compliance" pitch to your facility's board? Click here to take a quick survey.

Tip: Organizational independence
To achieve organizational independence, the audit department or compliance officer should report, and answer to the head of the organization. Furthermore, the department should be physically located away from the staff or management of the unit being audited.

Physician Provider Audits: The latest tools to analyze risk and benchmark compliance
Physicians rarely list coding and documentation among their top priorities. Many believe that such compliance concerns take time away from clinical care and have nothing to do with caring for patients. This is one of your toughest challenges as your facility tackles physician provider audits.

Other recently-published articles from Healthcare Auditing Weekly:

Florida man sentenced for selling patient information

Tip: Create a mission statement for your audit

DOJ recovers billions in settlements, judgments in FY2008

RAC permanent program on standby

OIG finds billions in inappropriate DSH payments

Tip: Determine if benefits outweigh risks when it comes to voluntary disclosure

Featured Audit Plan

OIG calls CMS out for lack of action in HIPAA enforcement

OIG investigates results of South Florida DME supplier appeals

Tip: Review your procedures for access patient information in an emergency

Tip: Follow the OIG’s suggestions for monitoring compliance program

Louisiana claims nearly $20M in unallowable costs for Katrina evacuees

FTC extends deadline for "Red Flags Rule"

Tip: Stay involved and informed in your role at your organization?s compliance program

Miami doctor and nurse convicted in $11 million fraud scheme

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