Corporate Compliance

Auditing against the OIG’s Compliance Program Guidance for Hospitals

Healthcare Auditing Weekly, April 18, 2006

This week we will continue our discussion of auditing against the OIG's Compliance Program Guidance for Hospitals with steps for identifying which auditing and monitoring provisions your hospital has incorporated. Evaluate whether your facility has achieved the following:

  • The compliance officer maintains all compliance reports created by ongoing monitoring, including reports of suspected noncompliance, and shares these reports with the hospital?s senior management and compliance committee

  • Internal or external auditors who perform periodic compliance audits have expertise in federal and state healthcare statutes, regulations, and federal healthcare-program requirements

  • Audits focus on the hospital?s external relationships with third-party contractors, specifically those with substantive exposure to government enforcement actions

  • Audits are designed to address the hospital?s compliance in the following areas:
    -Laws governing kickback arrangements
    -Stark
    -Inpatient and outpatient coding
    -Claim development and submission
    -Reimbursement
    -Cost reporting
    -Marketing

      The above tip is an excerpt from the book "Hospital Auditing and Monitoring: Sample Programs for Key Risk Areas." Copyright 2004 by HCPro, Inc. This book is a step-by-step, practical manual that offers sample audit programs for the most troublesome areas that a hospital must audit. The binder and CD-ROM are filled with actual audit programs used by auditors and compliance officers in the field. Click here for more information or to order your copy today.

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