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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.

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Healthcare Auditing Weekly

Issue 61, December 27, 2005

• Auditing against the OIG's Compliance Program Guidance for Hospitals

  This week, we'll conclude our four-part discussion of reviewing the claim development and...

• OIG: Connecticut hospital correctly accounted for dental residents

  John Dempsey Hospital of Farmington, CT correctly accounted for dental residents in full-time...

Issue 60, December 20, 2005

• Auditing against the OIG's Compliance Program Guidance for Hospitals

  This week we'll continue our four-part discussion of reviewing the claim development and submission...

• OIG: Ohio must pay back $142,964

  The OIG has recommended that the Ohio Department of Job and Family Services refund Medicaid...

Issue 59, December 29, 2005

• Auditing against the OIG's Compliance Program Guidance for Hospitals

  This week we'll continue our four-part discussion of reviewing the claim development and submission...

• Auditing against the OIG's Compliance Program Guidance for Hospitals

  This week we'll continue our four-part discussion of reviewing the claim development and submission...

• OIG delivers clean audit to California healthcare network

  Health Net of Woodland Hills, CA has received a clean audit from the OIG.

Issue 49, December 6, 2005

• Auditing against the OIG's Compliance Program Guidance for Hospitals

  Today, we'll continue our discussion of auditing against the OIG Compliance Program Guidance for...

• OIG: Colorado should repay $1.9 million

  The OIG has recommended that Colorado refund the federal government $1.9 million in light of an OIG...

Issue 48, November 29, 2005

• Auditing against the OIG's Compliance Program Guidance for Hospitals

  This week, we will continue our discussion of auditing against the Compliance Program Guidance for...

• OIG: Nursing home did not follow state rules for employee background checks

  An OIG audit has determined that the Willow Ridge Center nursing home in Hatboro, Pennsylvania...

Issue 47, November 22, 2005

• Auditing against the OIG's Compliance Program Guidance for Hospitals

  The OIG’s Compliance Program Guidance for Hospitals spells out the government's expectations...

• OIG completes the first in a series of FY 2003 cost report wage data

  The OIG has recommended that Day Kimball Hospital in Putnam, CT revise its 2003 cost report to...

Issue 46, November 15, 2005

• How to audit credentialing and privileging practices

  This week, we'll conclude our discussion of auditing your organization's credentialing and...

• OIG: New York must repay $43.3 million

  The OIG has recommended that the state of New York refund the federal government $43.3 million in...

Issue 45, November 8, 2005

• How to audit credentialing and privileging practices

  In this issue, we'll continue our discussion of auditing your organization's credentialing and...

• OIG: Home health agency must repay $63,425

  The OIG has recommended that Total Patient Care Home Health, LLC in Jacksonville, FL., repay...

Issue 44, November 1, 2005 - VIEW THE FULL ISSUE

• How to audit credentialing and privileging practices

  Last week, we discussed developing a checklist of data that the medical staff's office (MSO...

Issue 43, October 25, 2005

• How to audit credentialing and privileging practices

  Today, we'll continue our discussion of auditing your organization's credentialing and privileging...

• GOV’T AUDIT INSIDER OIG: Reimbursements for cancer drugs exceed cost

  The OIG has concluded that physician practices specializing in hematology, hematology/oncology, and...

• GOV’T AUDIT INSIDER OIG to North Carolina: Refund $8.2 million

  The OIG has determined that North Carolina should refund $8.2 million in federal money that was...

Issue 42, October 18, 2005

• How to audit credentialing and privileging practices

  This week, we will continue our discussion of how to audit your organization's credentialing and...

Issue 41, October 11, 2005

• How to audit credentialing and privileging practices

  For the next several weeks, we will discuss how to audit your organization's credentialing and...

• OIG: New York schools owe repayment of $96 million in transportation claims

  The OIG has determined that the New York City Department of Education (NYCDE) claimed $96 million...

Issue 40, October 4, 2005

• The OIG will audit for fraud and abuse in the wake of Hurricane Katrina

  It's no surprise to those involved in the compliance field: The wake of Hurricane Katrina has...

Issue 39, September 27, 2005

• Auditing graduate medical education

  This issue, we'll continue our discussion of steps for auditing graduate medical education. Last...

• OIG: State agency may be responsible for duplicate payments

  The Connecticut Department of Social Services may have overpaid as much as $1.8 million for home...

Issue 38, September 20, 2005

• Auditing graduate medical education

  Last week, we reviewed the first steps of auditing graduate medical education programs. This week...

• Are you ready for a clinical repository to support EHR?

  Wouldn’t it be nice if setting up a clinical repository to support your electronic health...

Issue 37, September 13, 2005

• Auditing graduate medical education

  Ensuring the accuracy of the resident full-time equivalent counts that your hospital uses for...

• GOV’T AUDIT INSIDER OIG recommends that CMS clarify cardiac rehab rules

  The OIG has recommended that CMS clarify national Medicare cardiac rehabilitation coverage...

• Watch those discharges: Postacute care transfer changes occur Oct. 1

  Whether your hospital is ready or not, October 1 marks the beginning of a new era, one that...

Issue 36, September 6, 2005

• Ambulatory payment classification monitoring

  This week, we continue our discussion of ways to ensure compliance with coding and claim...

• Medicaid overpayments to MOMS in New York

  The state of New York has received nearly $1.6 million in Medicaid payments for unapproved Medicaid...

Issue 35, August 30, 2005

• Ambulatory payment classification monitoring

  Over the next two weeks, we will discuss ways to ensure compliance with coding and claim...

• Unapproved allowances for institutionalized residents

  New Mexico Human Services Department (the State agency) increased the monthly personal needs...

Issue 34, August 23, 2005

• Four commonly used audit tools

  Last week we covered four tools commonly used by auditors: focus groups, interviews...

• California to give Medicare fraud tipsters up to $1,000 for leads

  Smalltime whistleblowers who provide information about schemes to defraud California’s...

• GOV’T AUDIT INSIDER: Improper Medicare billing in California

  Contrary to Medicare guidelines, Lake Forest, CA-based Garfield Imaging Center billed Medicare for...

Issue 33, August 16, 2005

• Four commonly used audit tools

  Last week, we covered steps to develop an audit plan for your organization. This week, we'll go...

• Court rules birth center newborns are entitled to EMTALA screening exams

  Consider this question: A woman is admitted to a hospital birthing center. She gives birth to a...

• GOV’T AUDIT INSIDER: Inappropriate home health therapy billing in LA

  Red Oak Home Health Services in Los Angeles received appropriately $187,627 in Medicare...

Issue 32, August 9, 2005

• Four steps to develop an audit plan

  Planning and audit is much like setting up a formal research study. Take these steps to develop an...

• Out-of-control physicians create risk for your hospital

  They’re abusive, short of temper, and degrading to employees. They may have impeccable...

• GOV'T AUDIT INSIDER Medicaid overpayments to MOMS in New York

  The state of New York has received nearly $1.6 million in Medicaid payments for unapproved...

Issue 31, August 2, 2005

• Create a training compliance plan

  A plan for compliance training can help ensure that every employee in your organization is trained...

• Conduct an audit of observation nursing services

  Hospitals often fail to code or capture the charges for nursing services performed at the bedside...

• GOV’T AUDIT INSIDER: Weaknesses found in Medicaid drug rebate programs

  An OIG summary report of audits of Medicaid drug rebate programs found that 45 states and the...

Issue 30, July 26, 2005

• Key components of a compliance report

  HIPAA outlines the responsibilities of covered entities for conducting compliance reviews, keeping...

• One hospital’s media relations solution to HIPAA: Part Two

  For many hospitals, receiving phone calls from the press inquiring about a patient's condition is...

• GOV’T AUDIT INSIDER: Unreported Medicaid overpayments in West Virginia

  West Virginia did not report Medicaid provider overpayments of $3.7 million to CMS because it was...

Issue 29, July 19, 2005

• Approaches to facility access control compliance

  HIPAA’s security rule requires that covered entities implement policies and procedures to...

• Having trouble finding a few good auditors? You’re not alone

  Filling an open healthcare auditor position isn’t easy. Depending on the position, a...

• Unreported Medicaid overpayments in South Dakota

  South Dakota did not report all or part of 342 Medicaid provider overpayments, totaling $229,792...

Issue 28, July 12, 2005

• Ensure integrity of electronic information

  HIPAA includes an integrity standard to ensure that electronic protected health information (ePHI...

• Verify that your staff know how to verify immigrant status

  The federal government will give hospitals money this year to offset the cost of treating illegal...

• GOV’T AUDIT INSIDER: Overstated claims of family planning service costs in Virg

  Virginia over claimed Medicaid family planning service costs by $3.7 million between April 2001 and...

Issue 27, July 5, 2005

• Conducting Stark audits: Part two

  Last week, we reviewed the first steps auditors should take to ensure compliance with Stark.

• Be prepared to speak with the media in a crisis

  If you’re fortunate, the only time your facility will ever deal with the media is when a...

• GOV’T AUDIT INSIDER: Overstated claims of family planning service costs in Mary

  Maryland overstated its claims of family planning service costs by $2.9 million between July 2000...

Issue 26, June 28, 2005

• Conducting Stark audits

  To ensure compliance with Stark (the physician self-referral law), you must be sure that your...

• Gainsharing may save money, but proceed with caution

  Financial leaders at your facility may be chomping at the gainsharing bit, now that the OIG has...

• GOV’T AUDIT INSIDER: Unreported Medicaid provider overpayments in Missouri

  Missouri’s accounts receivable system did not report 34 Medicaid provider overpayments on the...

Issue 25, June 21, 2005

• Auditing the registration process: Part four

  Last week, we discussed three steps for ensuring that the registration staff in your organization...

• Monitor restraint abuses to avoid false claims accusations

  Patients have the right to be free from medically unnecessary restraints, or those administered by...

• GOV’T AUDIT INSIDER: PA nursing facility falls short in staffing regulations co

  Beverly Healthcare of Reading, PA, complied with federal staffing laws and regulations, but did not...

Issue 24, June 14, 2005

• Auditing the registration process: Part three

  Last week, we discussed the second three steps you should take to ensure that the registration...

• Improve your facility’s medical necessity compliance

  If there’s one area of compliance the government will watch for years to come, you can bet on...

• Outdated methods cost IL $56.5 million

  Illinois used an out-of-date factor to convert billed charges to costs and did not have adequate...

Issue 23, June 8, 2005

• Auditing the registration process: Part two

  Last week, we discussed the first three steps you should take to ensure that the registration staff...

• Sentencing guidelines: What the new interpretation means for compliance

  In January, the U.S. Supreme Court reached a watershed decision, declaring the federal sentencing...

• Overpaid home health services in Connecticut

  Medicaid overpaid Connecticut Home Health Care (CHHC) in Trumbull, CT, by $41,940 for unallowable...

Issue 22, May 31, 2005

• Auditing the registration process

  It’s helpful to conduct an audit to ensure that the registration staff in your organization...

• Transplant centers: A high-risk area for billing mistakes

  When you turn over a rock, you never know what will crawl out from underneath

• GOV’T AUDIT INSIDER: Incorrect wage data reporting in Connecticut

  Windham Hospital in Willimantic, Connecticut incorrectly reported wage data by $404,402 for the...

Issue 20, May 17, 2005

• Ensuring clinical trials privacy

  To ensure that clinical trials in your organization fully comply with HIPAA, it helps to develop a...

• New auditors contracted by CMS will get a percentage of findings

  Scrutinizing thousands of Medicare claims forms would be a daunting task. However, receiving a cut...

• GOV’T AUDIT INSIDER: Medicare overpays New York hospital $8.4 million

  New York-Presbyterian Hospital overstated its direct graduate medical education (GME) and indirect...

Issue 19, May 10, 2005

• Tips for maintaining financial control

  It’s critical to stay on top of your organization’s financial statements to detect and...

• Prepare for HIPAA security compliance deadline this month

  According to Phoenix Health Systems, a consulting company that provides healthcare information...

• GOV’T AUDIT INSIDER: Accurate time studies needed in Kansas

  Kansas did not claim Medicaid reimbursement for administrative costs associated with school-based...

Issue 18, May 3, 2005

• Choosing a sample for SATH drug audits

  Last week we discussed which areas of your organization you should include in a self-administered...

• Create a policy for physician interactions with drug reps

  You may think drug sales representatives no longer lavish physicians with expensive trips and...

• GOV'T AUDIT INSIDER: Improper Medicaid cost claims in Vermont

  Vermont improperly claimed $262,219 in Medicaid costs related to skilled professional medical...

Issue 17, April 26, 2005

• Correctly billing SATH drugs

  It’s helpful to conduct an audit to determine whether your organization is correctly billing...

• Verify that your ER meets EMTALA compliance

  Flexibility, cooperation, and organization: An emergency room (ER) needs these characteristics to...

• GOV’T AUDIT INSIDER: Unallowed and unsupported costs at Seattle hospital

  Virginia Mason Medical Center in Seattle improperly claimed acquisition costs associated with...

Issue 16, April 19, 2005

• Federal IRB standards

  Last week we reviewed questions auditors should ask when reviewing the minutes of an institutional...

• CRNAs: A smart place to check for compliance

  Chances are, certified registered nurse anesthetists (CRNA) at your hospital require physician...

• GOV’T AUDIT INSIDER: Colorado overclaimed $1.5 million in family planning costs

  Colorado received $1.5 million in overpayments that did not qualify for federal Medicaid...

Issue 15, April 12, 2005

• Conducting an IRB Audit

  It’s a good idea to conduct an audit of your organization’s institutional review board...

• Audit vendors to keep feds away

  If your organization outsources billing and coding to a vendor, don’t assume that the vendor...

• GOV’T AUDIT INSIDER: Washington state should revise per diem rates, says OIG

  From January 2003 through June 2004, United Healthcare of Ohio received Medicare overpayments of...

Issue 14, April 5, 2005

• Conduct an audit to verify cash deposits

  Last week, we reviewed the steps auditors should take to ensure the proper handling of petty cash...

• Monitor OxyContin prescriptions to prevent OIG crackdowns

  The OIG is cracking down on physicians who prescribe too much OxyContin®, which means your...

• GOV’T AUDIT INSIDER: Washington state should revise per diem rates, says OIG

  The Medicaid funding that Washington state allowed Newport Community Hospital to retain was not...

Issue 13, March 29, 2005

• Correct handling of petty cash

  An audit of a physician practice should include a review of the organization’s cash and cash...

• Nail your next board presentation with these tips

  Let’s face it: Healthcare compliance involves a lot more than tracking codes and keeping up...

• GOV’T AUDIT INSIDER: Texas clinic overclaimed $12.4 million

  None of the Houston, TX-based Quitman Clinic’s 100 sampled claims for partial hospitalization...

Issue 12, March 22, 2005

• Review controls for drug storage, counting, and safekeeping

  Last week we discussed the steps auditors should take to ensure the effectiveness of their...

• Make global changes now to save time later

  To trim wasted minutes and minimize mistakes, take the time to periodically evaluate your...

• GOV’T AUDIT INSIDER: Oregon overclaimed more than $230.5 million

  Oregon incorrectly calculated upper payment limits (UPL) for non-state government nursing...

Issue 11, March 15, 2005

• Steps for a drug-purchasing audit

  An audit of the internal workings of your organization’s pharmacy will ensure that effective...

• What’s up ahead on the compliance horizon?

  Clinical research, unnecessary medical procedures, and information technology: If you’re...

• GOV’T AUDIT INSIDER: Kansas overclaimed more than $58 million

  Between April 1, 2001 and September 30, 2002, Kansas made upper payment limit (UPL) payments to...

Issue 10, March 8, 2005

• Determining the effectiveness of your compliance hotline

  A compliance hotline allows employees, vendors, and physicians to anonymously report compliance...

• Five tips to conquer your security risk assessment

  Although the Joint Commission on Accreditation for Healthcare Organizations (JCAHO) requires...

• GOV’T AUDIT INSIDER: OIG finds possible duplicate Medicaid claims in NH

  The New Hampshire Medicaid agency claimed $548,740 in suspected duplicate claims for the period of...

Issue 9, March 1, 2005

• Preparing for credentialing and privileging audits

  Conducting an audit of the medical staff office’s (MSO) credentialing and privileging...

• Anti-kickback statute: Stay alert to current regulatory trends

  You already know to steer clear of kickback arrangements, but you must remember that the...

• GOV’T AUDIT INSIDER: Medicaid overpayments total $1.4 million in Nebraska

  Nebraska’s Department of Health and Human Services Finance and Support delayed reporting 448...

Issue 8, February 22, 2005

• Identifying unfair claims denials

  Last week we learned about some of the reasons why claims are denied. However, there are some...

• There seems to be a problem-Now what should I do?

  It may be the hardest part of an auditor’s or compliance officer’s job-deciding what to...

• GOV’T AUDIT INSIDER: OIG finds Medicare overpayments to skilled nursing facilit

  Medicare improperly paid approximately $25,690 to skilled nursing facilities (SNF) that were under...

Issue 7, February 15, 2005

• Why are claims denied?

  An audit of your organization’s billing system will help to recoup lost dollars from claims...

• How to preserve attorney-client privilege

  Healthcare organizations that conduct internal investigations face two overriding needs: the need...

• GOV’T AUDIT INSIDER: Colorado claimed $1.1 million in unqualified family planni

  Colorado’s Department of Health Care Policy and Financing claimed more than $1.1 million that...

Issue 6, February 8, 2005

• Determining the appropriateness of admissions

  When a patient is admitted to your facility, it is important to be sure that the admission and...

• Strategies for monitoring and auditing HIPAA compliance

  Auditing and monitoring are essential to ensuring HIPAA compliance. An effective auditing and...

• GOV’T AUDIT INSIDER: Missouri cost reporting complies with federal standards

  Missouri’s Division of Medical Services, a program within the state’s Department of...

Issue 5, February 1, 2005

• Vendors: Audit purchasing and materials management contracts

  Vendor contracts for equipment and supplies represent a significant portion of a healthcare...

• GOV’T AUDIT INSIDER: Kansas agency failed to report all Medicaid overpayments

  The Kansas Department of Social and Rehabilitation Services did not report all Medicaid provider...

Issue 4, January 25, 2005

• Auditing a physician practice

  When auditing a physician practice, interview key employees.

• Batten down the hatches against false claims suits

  More than 75% of successful whistleblower actions in 2003 came from healthcare.

• GOV’T AUDIT INSIDER: Alabama hospital claimed $1.6 million in unallowable organ

  The University of Alabama at Birmingham Hospital (UAB Hospital) claimed $1.6 million in unallowable...

Issue 3, January 18, 2005

• Auditing observation services

  Conduct an audit to ensure that your organization is properly billing and coding observation...

• Auditing common EMTALA pitfalls

  The Emergency Medical Treatment and Labor Act (EMTALA) ensures that all emergency room patients...

• Risk assessment: Use questionnaires to identify management’s top issues

  One of the best ways to obtain information about the risk exposures facing your organization is to...

• GOV’T AUDIT INSIDER: WV healthcare agency to refund CMS $299,000 in overpayment

  The West Virginia Bureau for Medical Services improperly claimed the federal enhanced rate for 38...

• GOV’T AUDIT INSIDER: Enhanced family planning rates claimed in Arizona

  Arizona increased its claims of family planning services costs by $2.27 million between October...

Issue 2, January 11, 2005

• Assessing physician gifts

  When auditing physician practices to ensure that all of their contracts comply with the Stark law...

• Physician practice: Audit to verify compliance, efficiency

  Audits are essential to determine whether you are achieving your physician clinic’s goals and...

• GOV’T AUDIT INSIDER: Sufficient claims cost controls in California

  California had sufficient internal controls to ensure that costs claimed for the Medicaid Personal...

Issue 1, January 4, 2005

• Security risks

  Assessing your organization’s security risks and the degree of those risks can help protect...

• MS hospital turns to computers to ensure compliance

  At Forrest General Hospital in Hattiesburg, MS, ensuring compliance is no small matter.

• GOV’T AUDIT INSIDER: Overstated wage data at hospital in Massachusetts

  Cape Cod Hospital did not fully comply with Medicare regulations on reporting wage data in its...