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Government audit activity expected to ramp up


Non-profit providers are more likely to undergo government audits than their for-profit peers, according to research findings released by the Health Care Compliance Association (HCCA).

The HCCA survey also found that 42 percent of non-profit providers and 25 percent of for-profit providers underwent audits addressing the same issue by more than one government agency. In addition, while larger organizations were much more likely to be audited than smaller ones, the staffing levels needed at all provider institutions to meet audit demands are considerable, regardless of size, the survey said.

"Anyone who thinks the government is not doing enough to find fraud and abuse ought to look at this survey. The amount of government and healthcare resources devoted to these audits is staggering,” said Roy Snell CEO of HCCA in a press release. “And if that [were] not enough, I would not be surprised if these numbers increased significantly in the next few years.”

Audits from the Health & Human Services (HHS) Office for Civil Rights, HHS Office of Inspector General, Medicare Recovery Audit Contractor (RAC) and Medicaid RAC, as well as third-party payers were the most common audits reported and were significantly higher than audits from other governmental agencies. The most common audits – reported by 47 percent of respondents – were Medicare RAC audits, implemented to identify improper payments made on claims of healthcare services provided to Medicare beneficiaries.

Additional findings of survey:

  • The average number of audits reported over the previous 12 months by for-profit healthcare providers was just under four, while non-profits reported an average of six audits.
  • Centers for Medicare & Medicaid Services' comprehensive error rate testing audits, which measure improper payments in the Medicare fee-for-service program, were more common for non-profit organizations (53 percent) versus those for for-profit organizations (46 percent).
  • 30 percent of all respondents reported Medicare Administrative Contractor requests with non-profits again receiving more scrutiny (41 percent) reporting an audit.
  • Roughly half of respondents from institutions of 1,000 or more employees reported an audit, compared to just 27 percent from organizations of 251 to 1,000 employees.

 

According to the survey authors, “The range of organizations conducting the audits is likely adding to the amount and complexity of the workload. While most of the audits come from only a few regulatory bodies, it bears noting that respondents reported an enormous range of ongoing audits. This likely increases the complexity of the demands, and requires additional staff to meet such a wide range of potential audit needs.”

Photo attributed to Retama via Creative Commons license.

 

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