Corporate Compliance

Auditing against the OIG’s Compliance Program Guidance for Hospitals

Healthcare Auditing Weekly, April 25, 2006

Today we continue our discussion of auditing against the OIG's Compliance Program Guidance for Hospitals with steps for determining whether your organization follows appropriate auditing and monitoring provisions. To take this step, identify whether your facility's auditing and monitoring program:

  • Conducts audits focused on hospital compliance with specific rules and policies targeted by government FIs and carriers, law enforcement, and OIG fraud alerts and audits

  • Uses sampling protocols permit the compliance officer to identify and review variances from an established baseline while performing ongoing monitoring

  • Takes prompt steps to correct problems caused by improper procedures and misunderstanding of rules, including fraud and systemic problems

  • Promptly returns overpayments the affected payer, with appropriate documentation and a thorough explanation of the reason for the refund

      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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