Our Internal Audit Services Help Hospitals Maintain Compliance and Effectively Defend Against Billing Audits and Investigations
Hospital Consulting Team Lead – Timothy E. Allen | Former Special Agent (U.S. Secret Service & DOJ-OIG)
When it comes to compliance, implementing policies and procedures is only half of the battle. Hospitals must monitor and enforce compliance on an ongoing basis as well, and they must be prepared to demonstrate their compliance when necessary. If a hospital is unable to provide documentary proof that its compliance program is effective, this will raise questions during a billing audit or investigation, and avoiding recoupments and other penalties could be an uphill battle.
At Corporate Investigation Consulting, we provide comprehensive internal audit services for hospitals nationwide. We have specific experience in the healthcare sector, and many of our consultants and specialists previously investigated healthcare fraud cases at the U.S. Department of Health and Human Services (DHHS), Drug Enforcement Administration (DEA), and other agencies. We rely on sophisticated auditing techniques and in-depth knowledge of the federal billing rules and regulations to assess hospitals’ compliance efforts, and our audit services cover cybersecurity and other areas as well.
Put our highly experienced team on your side
Roger Bach
Former Special Agent (OIG)
Timothy E. Allen
Former Senior Special Agent U.S. Secret Service
Chris J. Quick
Former Special Agent (FBI & IRS-CI)
Maura Kelley
Former Special Agent (FBI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Michael S. Koslow
Former Supervisory Special Agent (DOD-OIG)
Marquis D. Pickett
Special Agent U.S. Secret Service (ret.)
Comprehensive and Streamlined Internal Audit Services for Hospitals
Hospitals must assess and reassess their compliance efforts on an ongoing basis. This is the only way to ensure that the hospital’s compliance program is serving its intended purpose, and it is the only way to uncover missteps before they lead to bigger problems. Conducting periodic internal audits also provides documentation of hospitals’ commitment to compliance—and this documentation can be critical during a federal healthcare audit or investigation.
With our consultants’ and specialists’ backgrounds as federal healthcare fraud investigators, we offer internal audit services that are tailored specifically to hospitals’ risks and needs. We further tailor our services to each individual hospital’s operations and payors, thus ensuring that we are able to provide a comprehensive assessment of the hospital’s compliance efforts as efficiently as possible. We conduct, manage, and oversee internal audits for hospitals involving:
- Medicare and Medicaid compliance
- Tricare compliance
- U.S. Department of Labor (DOL) compliance
- Private health insurance and PBM compliance
- Prescription drug compliance
- Anti-kickback compliance
- Telemedicine and medical licensing compliance
- HIPAA compliance
- Privacy compliance
- Cybersecurity compliance and threat assessments
- Patient and employee complaints
In addition to conducting scheduled internal compliance audits, we are also able to assist with conducting internal audits on an as-needed basis. This includes conducting internal billing compliance audits in anticipation of federal inquiries, as well as conducting internal cybersecurity audits in response to threats and intrusions.
When conducting an internal audit, there are several important considerations that need to be taken into account. For example, it is important to carefully choose the personnel who are involved in the audit, as even the perception of bias can call the audit’s findings into question. Similarly, it is important to comprehensively identify all pertinent data sources, as overlooking even a single source will lead to uninformed – and potentially risky – decisions.
FAQs: Hospital Internal Compliance Audits
Q: When should hospitals conduct internal audits?
There are two answers to this question. First, hospitals should conduct internal compliance audits on a periodic basis—at least annually, but potentially more frequently depending upon the specifics of the hospital’s operations and its compliance history. These periodic audits are intended to proactively assess the hospital’s compliance, and to facilitate the correction of any issues or shortcomings before they lead to larger problems.
Second, hospitals should conduct internal audits when potential exposure events arise. This includes primarily: (i) federal healthcare audits and investigations; and, (ii) cybersecurity threats. However, employee complaints, patient complaints, and various other issues can trigger the need for an internal audit as well.
Q: Does my hospital need to engage an outside consulting firm to conduct its internal audits?
When conducting an internal audit, it is strongly in a hospital’s best interests to engage an outside consulting firm. There are two primary reasons why. First, an outside consulting firm can offer insights and expertise that your hospital’s staff members are lacking. Second, engaging an outside consulting firm eliminates any concern about bias in the process.
Q: What should my hospital do with the information obtained during an internal audit?
What should be done with the information obtained during an audit depends on the nature of the information. Did the audit confirm that your hospital’s compliance program is functioning as intended? If so, then you can simply keep the audit records on hand to demonstrate good-faith compliance to federal agents or regulators when necessary. Did the audit uncover compliance deficiencies? If there is work to be done, then your hospital will want to use the insights gained from the audit to update or improve its compliance program as necessary.
Q: Why is it important to conduct an internal audit when facing a federal healthcare audit or investigation?
It is important to conduct an internal audit when facing a federal healthcare audit or investigation because you need to know what (if anything) the auditors or investigators are going to find. You do not want to be caught off guard. Additionally, if federal auditors or investigators make flawed assumptions, rely on faulty methodologies, or make other mistakes, you need to be prepared to call out these miscues so that your hospital is not penalized unfairly.
Q: Does Corporate Investigation Consulting conduct internal audits for hospitals remotely or on-site?
At Corporate Investigation Consulting, we can conduct internal audits both remotely and on-site. If all pertinent data are stored electronically, we can securely connect with the hospital’s IT system and work remotely. However, we can also work on-site if necessary or if preferred; and, when working on-site we can maintain strict confidentiality without disrupting your hospital’s day-to-day operations.
Contact Us to Learn More about Our Internal Audit Services for Hospitals
For more information about our internal audit services for hospitals, please contact us to speak with one of our senior hospital consultants or compliance specialists in confidence. Call 866-352-9324 or contact us online to learn how we can help protect your hospital today.