auditing

The evolution of healthcare analytics has transformed healthcare operations from retrospective data hunting into a fast-paced environment managed by near-real-time visualizations.

Every medical auditor has experienced it. I don’t know about you, but I can honestly say that I have audited some notes in my day that left me feeling like a teacher with a red pen grading a test—and the note ended up with a big fat “F.”

A statistically significant chart audit in healthcare is a structured, randomized review of medical records designed to project findings onto an entire population of claims (the "universe") with measurable reliability.

The following cases highlight fraud, waste, and abuse (FWA) and serve as a reminder to uphold high ethical standards when providing patient care and services.

A 76-year-old man was arraigned on four counts of felony Medicaid Fraud.

In the constantly changing landscape of healthcare, regardless of the size of your organization, the question is not if you will be audited, the better question is when you will be audited.

Patient care remains the top priority for healthcare providers. But in a swiftly evolving technological world, conventional methods for managing and enhancing care might fall short.

In the first two articles over mid-level fraud indicators, we covered signs and solutions to the problem individuals. In this article we cover signs and methods to address auditors who have been “turned” into internal threats or “moles”; informing on their coworkers and/or teammates.

Fraud cannot be eliminated. No system is completely fraud-proof, as any system can be bypassed or manipulated. However, it can be detected early by paying greater attention to common fraud indicators. This article follows a road less-traveled by discussing the potential of audit managers knowingly skewing audit results, causing unintended consequences within what appears to be a well-functioning compliance program.

Delivering audit results to healthcare providers is rarely a straightforward task.