ISO internal audits are an essential aspect of a company’s compliance mechanisms, particularly if the corporation conducts business internationally. Implementing international standards of quality is only the first step in the compliance process; companies also have to take care to conduct regular internal audits to ensure that the correct procedures are actually being followed and that the resulting goods and services hold up to the appropriate standards.

The internal auditing professionals at Corporate Investigation Consulting help companies, both large and small, take the steps necessary to come into compliance with ISO standards and then maintain their certifications through a rigorous internal auditing process.

The ISO Compliance System

The International Organization for Standardization (ISO) has set a host of standards for businesses to voluntarily comply with. These standards are meant to ensure that the company’s products and services meet expectations in regards to quality and safety. Companies that meet these standards can become ISO certified – a designation that carries great importance in international business. Companies that are currently certified by the ISO can be trusted to meet at least the minimal standards required by the organization. This lets customers and other businesses reasonably anticipate and rely on the company’s products being consistent and dependable.

However, ISO does not just require companies to meet their standards for quality. The ISO also demands that companies maintain that level of quality. This is to ensure that ISO certification continues to carry meaning. Otherwise, companies could meet ISO’s standards, get certified, and then immediately roll back their efforts of dependability in order to cut down on costs.

Instead, part of ISO’s required standards involve regular internal ISO audits. These audits must ensure that the compliance mechanisms adopted by the company to meet ISO standards are still being followed and upheld. Not conducting these internal ISO audits can imperil the company’s ISO certification. If that certification is lost, other businesses and customers are likely to seek their goods or services elsewhere, knowing that losing certification means that the company has had internal setbacks that have hampered the quality of what it produces.

The Many Different Types of ISO Audits

Because there are so many different ISO standards that have to be met in order to get certified by the organization, there are also numerous different types of internal ISO audits. Each of these types of audits inspect distinct business practices and protocols that bring the company into compliance with unique ISO certification requirements, such as the following standards:

• ISO 9001
• ISO 13485
• ISO 14001
• ISO 14971
• ISO 17025
• ISO 20000
• ISO 27001
• ISO/IEC 17025
• ISO/TS 16949
• OHSAS 18001
• R2 and RIOS recycling
• AS9100
• AS9110

Just a few of the types of ISO audits that can be performed to ensure compliance with these standards are:

• Gap analysis
• Supplier audits
• Pre-assessment audits
• Internal audits
• Complete audit program maintenance inspections

The auditing professionals at Corporate Investigation Consulting can help on any of these fronts.

Gap Analysis

A gap analysis is a crucial part of implementing an ISO compliance scheme. The analysis reviews a company’s current compliance infrastructure, compares them to the needs that have to be met in order to satisfy the targeted ISO standard, and identifies the gaps between what exists and what needs to be in place. Implementing an ISO compliance protocol without doing a gap analysis first is a blind endeavor that is almost certain to miss important aspects of compliance or create duplicative or needless compliance policies.

Supplier Audits

Unfortunately, coming into compliance with ISO standards is not something that only involves the company seeking certification. No company exists in a vacuum. Shortcomings by a company’s supplier can prevent that company from meeting ISO’s stringent expectations. Just because it is a third party that is responsible for the shortfall does not absolve the company seeking ISO certification.

Auditing suppliers is a critical component of seeking ISO certification. By examining suppliers’ services early on in the process, companies can identify weak components in their supply chain and issues that can affect their certification efforts. It can also pinpoint problems that can be improved upon, to the company’s benefit.

Pre-Assessment Audits

One of the last steps to take before applying for ISO certification is to conduct a pre-assessment audit to ensure that the steps that have been taken are satisfactory. ISO will assess them as a part of the certification process. Performing your own pre-assessment audit before applying for ISO certification can discover potential shortcomings that can doom your application.

Internal Audits

Companies that have been certified by the ISO still have to actively audit their compliance measures to make sure they are still working the way they are supposed to work.

These internal audits have to meet the expectations of ISO 19011:2018, the standard promulgated by the ISO to cover these internal audits.

Conducting Internal ISO Audits

Internal ISO audits can be performed by auditors within the company or by external auditing teams. Generally, external audits performed by professionals, like those at Corporate Investigation Consulting, are considered to be more reliable, as they do not carry the potential for conflicts of interest that are always present when the audit is done in-house.

Regardless of who conducts the internal audit, though, certain steps will have to be taken before, during, and after it. A few of these are to:

• Identify the precise type of audit to be performed
• Isolate which ISO standards are at play or have to be met
• Determine the audit’s scope and depth
• Figure out which types of evidence will be reviewed while conducting the audit
• Set a timeframe
• Define noncompliance
• Gather all evidence within the scope of the audit
• Plan how to correct any shortcomings that were discovered in the review

Each of these steps have to be thorough in order for the audit to have its desired outcome.

Some Frequently Asked Questions About ISO Internal Auditing and Corporate Investigations Consulting’s Services

Corporate Investigation Consulting Provides ISO Internal Auditing Services

ISO internal audits are a crucial component of protecting one of the most important certifications that many companies have: Their ISO certification. Customers, other businesses, and potential clients often look for ISO certification before conducting business with a company, as it signals a base level of quality that they know that they can expect. Not having an ISO certification or, worse, losing it sends a strong signal to potential business prospects that your company may be too risky for them.

Performing internal ISO audits are required for maintaining that certification.

The auditing professionals at Corporate Investigation Consulting have helped numerous corporations maintain their ISO compliance and protect their certification. Contact them online or call their offices at (866) 352-9324 to tap into their extensive experience.

Conducting an internal I-9 audit is an important part of every company’s compliance protocols. Companies that do not regularly conduct internal audits of their I-9 records can find themselves subjected to serious allegations of noncompliance from the U.S. Department of Homeland Security’s Immigration Customs and Enforcement (ICE). If proven, those allegations can lead to substantial fines and other sanctions. Even if not proven, the allegations themselves can lead to lots of bad press and a tarnished reputation.

The internal auditing professionals at Corporate Investigation Consulting have provided effective and efficient I-9 audits for companies across the country. With their experience, these companies have taken the steps necessary to insulate themselves from legal liability in both immigration and employment law as well as to avoid a needless allegation of wrongdoing that could hurt their business’ brand, all while avoiding harmful accusations of discriminating against workers.

I-9 Audits: Ensuring All Workers are Eligible to Work in the United States

Under the terms of the Immigration Reform and Control Act of 1986 and the regulations associated with it, all employers in the U.S. have to complete an I-9 Form whenever they hire someone. This Form requires employees to attest, under penalty of perjury, their citizenship status as either:

• A U.S. citizen
• A noncitizen U.S. national
• A lawful permanent resident, along with their Alien Registration Number or USCIS Number
• An alien authorized to work in the U.S., along with details about when their authorization expires

Authorized aliens have to supply one of the following documents in support of their attestation on the I-9 Form:

• Alien Registration Number or USCIS Number
• Form I-94 Admission Number
• Foreign Passport Number and its country of issuance

Employees have to complete their I-9 Form no later than their first day of employment. However, in order to prevent employment discrimination based on immigration status or national origin, they cannot be required to complete it before accepting a job offer.

The employer then has to complete its section of the I-9 Form without three days of the worker’s first day of employment. Someone from the employing organization has to physically examine documentation provided in support of the employee’s claim that he or she is eligible to work in the United States. The employee has to be present during this examination of their immigration documents. The agent for the employer who examines the documents must be the one signing the I-9 Form on behalf of the employer.

Goals of I-9 Forms are Conflicting and Complex

The I-9 process operates in a sensitive and politically fraught intersection between employment law and immigration law. As a result, employers can find themselves in legal jeopardy if they do too little or if they do too much.

On the one hand, immigration laws are meant to protect American assets, such as jobs and taxpayer-funded government benefits, from migrants while still maximizing the benefits that immigration provides to the country.

On the other hand, employment laws are designed to protect workers from unlawful conduct by their employers, including but not limited to retaliation or discriminatory hiring and employment practices. For migrant workers and noncitizens, discrimination is a real threat to their livelihoods. They can be discriminated against based on their:

• National origin
• Citizenship status
• Skin color
• Race

The I-9 process aims to walk the line between these conflicting interests, allowing American employers to benefit from a reasonable amount of migrant labor while still providing those workers the legal protections that they need to work efficiently and securely.

How to Conduct an Internal I-9 Audit

Establishing formal procedures for an internal I-9 audit and then sticking to them can show immigration enforcement and regulators that your company is taking its legal obligations seriously. By conducting these audits regularly, you can detect issues that could escalate into full-blown legal problems before they can do so.

At the very minimum, these internal I-9 audits should:

• Gather all of the I-9s to be audited
• Correct errors made by the employee
• Correct any errors made by the employer
• Make sure records are being properly maintained
• Maintain and update an audit log

Depending on the needs and concerns of the company, an I-9 audit’s scope can be limited to just a sampling or can include all of the I-9 Forms on record. This includes I-9s from former employees who were either terminated in the last 12 months or were hired within the last three years. While complete audits are more thorough, they are also more time-consuming. Additionally, only reviewing a sample can potentially open the company up to allegations of discrimination for treating certain workers differently than others.

If an I-9 has inaccuracies, missing information, or false information from the employee, the employer is not allowed to correct it. Only the employee can fix it. They have to date and initial the alternation to the record for it to be binding.

Mistakes on the I-9 made by the employer can be fixed without the employee’s presence. All alterations must still be dated and initialed by the person making the change.

Throughout this process, I-9 auditors should maintain a log of the documents that were reviewed and the changes that were made to them. This creates a contemporaneous record of the audit. Additionally, auditors should make sure that the required recordkeeping obligations are being followed for the I-9 Forms.

For more details on this process, read our I-9 audit checklist and recommendations article.

Several FAQs About I-9 Forms, I-9 Auditing, and Corporate Investigation Consulting’s Services

I-9 Audits are Not Legally Required, But are Highly Recommended

According to ICE guidance on the topic, I-9 self-audits are not legally required by federal law. However, they are highly recommended to ensure continued compliance with immigration and employment law. Not performing these audits can leave dishonest employee attestations unchecked, which can expose the company to legal problems as well as allegations of not taking its compliance obligations seriously.

The I-9 Auditing Professionals at Corporate Investigation Consulting

Conducting an internal I-9 audit is a sensitive but often necessary endeavor. Not performing one can expose your company to a delicate legal situation that can quickly and easily escalate. However, performing an I-9 audit improperly can also get the company accused of employment discrimination and retaliation.

The I-9 auditors at Corporate Investigation Consulting have guided numerous companies between these two legal threats. Contact them online or call their offices at (866) 352-9324 for help.

Conducting internal audits is an essential and legally required component of a company’s compliance obligations under the Sarbanes-Oxley Act. As the last step in a successful compliance setup, internal audits can ensure that your compliance protocols are working the way they are supposed to work and insulating your company from potential legal liability and scrutiny.

The internal auditing team at Corporate Investigation Consulting has helped numerous publicly traded corporations and accounting firms come into not just strict compliance with the Sarbanes-Oxley Act, but also efficient compliance that does not needlessly sap the company’s resources in its compliance efforts.

The Sarbanes-Oxley Act

The Sarbanes-Oxley Act, sometimes referred to as Sarbox or SOX, is a federal law that was passed in reaction to the Enron scandal.

In that scandal, as well as other scandals like it, Enron and its accounting firm, Arthur Andersen, used fraudulent accounting methods to hide the extent of its financial liabilities. This let the company continue to solicit confident investments with healthy financial reports, even though it was drowning in debt. When the debt finally proved to be too much, Enron declared bankruptcy in an announcement that shocked the business world, which had been led to believe that it was still extremely profitable. The loss in value left shareholders with billions of dollars in securities of the company that had become worthless nearly overnight.

The Sarbanes-Oxley Act was meant to protect consumers and investors by keeping this type of scandal from happening again. It passed with extremely little dissent in Congress and was signed into law in 2002 by President George W. Bush.

The Act focuses on the role of the auditors who failed to detect, or who actively enabled, accounting fraud that was meant to hide a company’s value. It also empowers the U.S. Securities and Exchange Commission (SEC) to promulgate further rules to enforce the law.

Among the most important aspects of the Sarbanes-Oxley Act is the requirement that all publicly traded corporations in the U.S. to have internal controls that ensure their financial records are reliable and to audit those records and controls at least annually.

Covered Companies Must Have Internal Controls

Section 404 of the Sarbanes-Oxley Act (15 U.S.C. § 7262) requires all covered corporations to create and implement internal controls to find and to prevent errors and falsifications in the company’s financial records. While each corporation may create its own set of internal controls that is best tailored to its needs and circumstances, they generally have to include:

• Direct responsibility of the corporation’s senior management, typically the CEO or CFO, over any financial report that gets filed with the SEC and over the success of the internal controls, themselves
• Ongoing compliance requirements for the corporation to meet
• A data security policy to protect the use and storage of financial information

These controls then need to be audited regularly by external auditors who are sufficiently independent from the company.

The Goals of a Sarbanes-Oxley Internal Audit

The bulk of a Sarbanes-Oxley internal audit focuses on the internal controls that are meant to ensure the accuracy of the company’s financial information and prevent errors and fraud from infiltrating it. These audits include the cybersecurity and network systems that handle the company’s financial information. This includes reviewing:

• Information technology (IT) security
• Data backup
• Access controls
• Change management

Problems on any of these fronts can alter the financial statements that the corporation produces and distributes to its shareholders and to potential investors. Because incorrect financial statements can harm investors and the public, the Sarbanes-Oxley Act makes senior management within the corporation directly responsible for the contents of those statements. They can be held civilly or potentially even criminally liable for errors or fraud in them. Conducting an internal audit can avoid this outcome.

Penalties of Noncompliance

Auditing a corporation’s internal controls for producing a reliable financial statement or report is crucial, not just for the Sarbanes-Oxley Act, but for the company’s continued upstanding reputation. Public corporations that release suspicious statements about the health of the company’s finances can draw increased scrutiny and raise the eyebrows of both regulators and the investing public, undermining the company’s financial success and ability to raise funding. With such massive accounting scandals in the recent past that have cost investors billions of dollars, expectations are high.

With the Sarbanes-Oxley Act, though, not meeting those expectations also runs afoul of the law and can lead to substantial penalties. Because SOX makes high-level executives personally responsible for the veracity of their corporation’s financial reports, it can also lead to prison time. If an executive knowingly certifies a financial report that does not live up to the standards required under the Sarbanes-Oxley Act, they can face up to a million dollars in fines and a decade in federal prison.

Frequently Asked Questions About SOX Compliance, Internal Auditing, and Corporate Investigation Consultants

The Sarbanes-Oxley Auditors at Corporate Investigation Consulting

Coming into compliance with all of the legal requirements of the Sarbanes-Oxley Act is a daunting task. Hiring an auditing team that understands the ins and outs of the law can be tricky. Numerous firms say that they know how to perform internal audits that satisfy the Sarbanes-Oxley Act, but not all of them can live up to their claims.

The internal auditing team at Corporate Investigation Consulting team, however, is made up of numerous investigators and agents who have spent years within the SEC and other major federal law enforcement agencies, including the Federal Bureau of Investigation (FBI) and the U.S. Department of Justice (DOJ). We know how companies can best comply with the Sarbanes-Oxley Act because we have helped prosecutors investigate and pursue cases of alleged noncompliance.

Call our auditing firm at (866) 352-9324 or contact us online to get started on your situation.

Our Former OIG Healthcare Fraud Investigators Protect Healthcare Providers During Medicare Audits

Medicare audits present substantial risks for participating healthcare providers. Not only can these audits lead to recoupment demands, prepayment review, and other administrative penalties, but they can also trigger civil or criminal healthcare fraud investigations. Providers that are facing scrutiny need to prioritize their defense, and they need to ensure that they have a clear understanding of the risks and challenges involved.

Former OIG Healthcare Fraud Investigators with Proven Results in Medicare Audit Defense

Our former OIG healthcare fraud investigators provide Medicare audit defense services for physician practices, pharmacies, hospitals, clinics, laboratories, and other healthcare entities nationwide. As a result of our consultants’ vast government experience, we are extremely well-versed in the rules, process, and procedures that govern Medicare audits. We use our government experience to our clients’ advantage, and we have a proven track record of helping providers and other businesses avoid unnecessary liability and other consequences during (and after) the audit process.

Medicare Audit Defense: What Healthcare Providers and Business Owners Need to Know

Successfully defending against a Medicare audit requires an informed approach. Healthcare providers and business owners need to have a clear understanding of the audit process, the potential outcomes, and their legal rights. When engaged for Medicare audit defense, we walk physicians, pharmacists, executives, and business owners through everything they need to know, and then we get to work quickly putting the framework in place so we can execute an efficient and strategic defense.

Here are some important facts to know if your healthcare practice or business is facing a Medicare audit:

1. You Need to Know What Entity is Conducting the Audit

While federal agencies like the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) conduct Medicare audits, so do private contractors. The Centers for Medicare and Medicaid Services (CMS) engage private companies to conduct Medicare audits on a “fee-for-service” basis. This means that these companies have a financial incentive to uncover overpayments only—and this significantly influences the audit process.

But, while dealing with a MAC, RAC, or UPIC presents some unique challenges, so does dealing with the federal government. If the OIG (or another federal agency) is conducting the audit, this requires a particular approach as well. So, identifying the entity that is auditing your practice or business is the first step toward an effective defense.

2. A Medicare Audit Should Not Be a Unilateral Process

Too often, healthcare providers and business owners make the mistake of allowing auditors to examine their billing records without oversight. This invites a host of problems, and it can lead to scrutiny of billings (and other practices) that shouldn’t be subject to review. A Medicare audit should not be a unilateral process. Instead, providers and businesses that are facing audits should take a proactive approach to their defense, and they should engage a team of expert Medicare billing and audit defense consultants to deal with the audit for them.

3. Medicare Audits Can (and Frequently Do) Lead to Unwarranted Consequences

While auditing plays an important role in preventing fraud, waste, and abuse in the Medicare system, it also frequently leads to unwarranted consequences for legitimate healthcare providers and other businesses. The unfortunate reality is that even many auditors do not have a comprehensive and accurate understanding of the extraordinarily complex Medicare billing rules and regulations. Additionally, CMS’s “fee-for-service” audit program incentivizes private contractors to pursue maximum recoupments, and this unfortunately also leads to unjustified audit results in some cases.

All of this means that healthcare providers and business owners cannot trust the audit process—and they cannot simply allow a Medicare audit to run its course. Instead, they need to scrutinize auditors’ methods and conclusions, and they need to proactively address any issues that have the potential to lead to unwarranted or unnecessary consequences.

4. The Consequences of a Medicare Audit Can Be Significant

Speaking of consequences, the consequences of a Medicare audit can be significant. Under the Medicare billing regulations and CMS’s “fee-for-service” audit rules, findings of improper billings can lead to:

• Recoupment demands
• Denial of pending claims
• Prepayment review of future Medicare billings
• Additional fines and financial penalties
• Temporary or permanent exclusion from Medicare

If auditors conclude that a provider’s billing violations (or alleged billing violations) rise to the level of healthcare fraud, they can also refer providers and businesses for investigation. Investigations conducted by the OIG, U.S. Department of Justice (DOJ), and other federal agencies can potentially lead to civil or criminal charges. Some examples of audit findings that may trigger a referral include:

• Billing for “medically-unnecessary” services (as defined by the Medicare billing regulations)
• Billing for “medically-unnecessary” equipment or supplies
• Billing for services not actually rendered (auditors refer to this as “phantom billing”)
• Double-billing Medicare and other payors (whether private or public)
• Upcoding, unbundling, and other common billing and coding errors

5. Targeted Providers and Businesses Can (and Should) Take Control of the Process

At Corporate Investigation Consulting, we take control of the Medicare audit process for our clients. We intervene in the process immediately, establish lines of communication, and make clear that we will be scrutinizing all aspects of the audit. When auditors overreach or make mistakes, we address these issues right away, and we keep the audit on a narrow track so that it gets resolved as quickly and favorably as possible.

Our Process for Medicare Audit Defense

While facing a Medicare audit can be dangerous, this doesn’t have to be the case. At Corporate Investigation Consulting, we take a systematic approach to defending healthcare providers and businesses nationwide during the audit process. In all scenarios, our process involves:

• Intervening in the Audit – We intervene in our clients’ Medicare audits immediately. We let the auditors know that all communications need to run through us, and we take the burden of dealing with the audit off of our clients’ shoulders.
• Examining the Relevant Billing Records – We promptly review our clients’ relevant billing records to assess their risk in the audit. We then build custom-tailored audit defense strategies based on the circumstances at hand.
• Controlling the Auditors’ Access to Information – Throughout the process, we strictly control the auditors’ access to information. We ensure that they do not talk to internal personnel without authorization, and we ensure that they do not obtain records that are ineligible for review.
• Scrutinizing the Auditors’ Methods, Practices, and Conclusions – We scrutinize the auditors’ methods and practices throughout the process as well. When they misapply the Medicare billing regulations or calculate Medicare’s liability incorrectly, we address this right away.
• Demonstrating Medicare Billing Compliance and Proactively Resolving Issues as Necessary – When it makes sense to do so, we take steps to affirmatively demonstrate our clients’ adherence to an effective Medicare billing compliance program. When it is necessary to do so, we work to resolve issues proactively before they lead to unnecessary outcomes.

FAQs: Avoiding Unnecessary Consequences During a Medicare Audit

Contact Us for a Complimentary Initial Consultation Today

Are you facing a Medicare audit? If so, we encourage you to contact us promptly to learn more about how we can help. To arrange a complimentary initial consultation with a Medicare audit defense consultant at Corporate Investigation Consulting, please call 888-352-9324 or tell us how we can reach you online now.

Healthcare Providers Facing OIG Audits Need to Avoid Mistakes that Can Lead to Unnecessary Recoupments and Penalties

Healthcare providers in the United States can face scrutiny from several sources. Along with private insurance auditors and plaintiffs’ medical malpractice lawyers, this includes the federal government. Multiple federal agencies have oversight of the healthcare sector in the U.S., including the U.S. Department of Health and Human Services’ Office of Inspector General (OIG).

When scrutinizing healthcare providers, the OIG’s main focus is billing compliance. The OIG expects all Medicare and Medicaid-participating providers to strictly comply with these programs’ billing requirements. It also expects providers to have documentation that proves their compliance. During OIG audits, this documentation is critical, and providers that can affirmatively demonstrate compliance can usually resolve their audits quickly (at least relatively speaking) and without unnecessary consequences.

Former OIG Agents Assisting Healthcare Providers with Audit Defense

But, even when healthcare providers have the documentation they need to withstand scrutiny during an OIG audit, avoiding unnecessary consequences isn’t easy. It requires an informed approach to the audit process, and it requires an in-depth understanding of the governing rules and procedures. Far too often, healthcare providers end up repaying funds they don’t have to repay, and they end up facing other penalties that they could—and should—have avoided.

We help healthcare providers avoid these mistakes.

If you are a physician, pharmacist, or healthcare administrator or executive, it is important that you seek outside help during an OIG audit. Due to the unique procedures, considerations, and risks involved, these are not matters that most healthcare providers and facilities are prepared to handle in-house. Handling an OIG audit successfully requires special expertise, and this expertise can only be gained from years of relevant experience.

Our team of healthcare audit and compliance consultants includes former agents with the OIG and other federal healthcare agencies. Combined, our consultants have centuries of combined experience on both sides of healthcare audits, including OIG audits among others. We know what to expect at all stages of the OIG audit process, and we know how to prepare and respond to ensure that providers do not face unnecessary and unwarranted consequences.

OIG Audit Defense: What Healthcare Providers Need to Know

Is the OIG auditing your healthcare practice, facility, or business? If so, there is a lot you need to know. You need to be making informed decisions, and you need to be sure that you are not doing anything that could put your practice in jeopardy. In addition to recoupments and other administrative penalties, OIG audits can also lead to civil—or even criminal—healthcare fraud enforcement actions in some cases.

5 Important Facts About OIG Audits for Healthcare Providers

OIG audits are unique procedures that present unique challenges. Here are five important facts all healthcare providers, administrators, and executives need to know:

1. OIG Audits are Complex

OIG audits are complex. They can examine years’ worth of billing records, and they can focus on numerous types of potential Medicare and Medicaid billing violations. Ensuring that OIG auditors have access to everything they need—and nothing they don’t—is a process in itself, and providers who are being audited need to take an organized and structured approach to their defense.

2. OIG Audits are High-Risk

As we mentioned above, OIG audits present significant risks. While it is very possible to resolve an OIG audit without liability, it is equally possible for an audit to lead to civil or criminal prosecution. Under no circumstances can healthcare providers afford to take the outcome of an OIG audit for granted.

3. There Are Limits On What Auditors Can Do

While the OIG has substantial authority to investigate billing fraud and hold non-compliant healthcare providers accountable, there are limits on what the OIG’s auditors can do. When facing an audit, it is critical to hold auditors to their limitations. If auditors are allowed to examine billings that are no longer subject to review, or if they are allowed access to records or personnel that are beyond the scope of their audit, this can lead to problems that could (and should) have been avoided.

4. OIG Auditors Sometimes Make Mistakes

Just like healthcare providers, OIG auditors sometimes make mistakes. This is one of the most important reasons to engage an outside consulting firm during an audit. If auditors misapply the Medicare or Medicaid billing regulations, misinterpret a provider’s billing records, or miscalculate the reimbursements that providers are rightfully owed, these are all issues that can have unjust consequences. But, without a comprehensive understanding of the rules and regulations governing OIG audits and federal billing compliance, these issues can be difficult (if not impossible) to detect.

5. There are Methods for Avoiding Unnecessary Consequences

While OIG audits can feel overwhelming (and they can be overwhelming for providers that aren’t prepared), there are methods for avoiding unnecessary consequences. At Corporate Investigation Consulting, we take a systematic approach backed by years of relevant experience to guide our clients’ OIG audits toward positive outcomes.

5 Mistakes to Avoid During an OIG Audit

As we mentioned in the introduction, mistakes made during an OIG audit can prove to be incredibly costly. Some of the mistakes we see healthcare providers make far too frequently include:

1. Giving OIG Auditors Have Full Access to Billing Records

When facing OIG audits, healthcare providers should not give auditors full access to their billing records. Instead, providers should ensure that auditors are only reviewing the records that fall within the scope of the audit.

2. Allowing OIG Auditors to Talk to Internal Personnel

While it may be appropriate for internal personnel to speak with the OIG’s auditors in some circumstances, this should not be the default approach. To avoid issues, all communications should flow through the provider’s outside consulting firm.

3. Failing to Play an Active Role in the Audit

An OIG audit is not, or shouldn’t be, a unilateral proposition. To protect themselves, healthcare providers need to play an active role in the process.

4. Failing to Raise Concerns During the Audit Process

If you have concerns during an OIG audit, you should not take a wait-and-see approach, and you should not save your concerns for the end of the process. This approach allows issues to snowball, and it is far more difficult to challenge the outcome of an OIG audit than it is to resolve issues while the audit is still pending.

5. Assuming the Outcome of the Audit Will Be Fair

Even though an OIG audit is a federal government procedure that is simply supposed to help protect Medicare and Medicaid from fraud, waste, and abuse, you cannot assume that the outcome of your OIG audit will be fair. It might not be; and, if it isn’t, you could end up facing recoupments, fines, denial of pending claims, prepayment review, and other consequences that are unwarranted.

FAQs: Avoiding Unnecessary Recoupments and Penalties During OIG Audits

Speak with an OIG Audit Defense Consultant in Confidence

For more information about how we help healthcare providers avoid unnecessary consequences during OIG audits, contact us today. Call 888-352-9324 or submit your contact information online to arrange a complimentary initial consultation.

Our Former OIG Healthcare Fraud Investigators Protect Healthcare Providers During Medicare Audits

Medicare audits present substantial risks for participating healthcare providers. Not only can these audits lead to recoupment demands, prepayment review, and other administrative penalties, but they can also trigger civil or criminal healthcare fraud investigations. Providers that are facing scrutiny need to prioritize their defense, and they need to ensure that they have a clear understanding of the risks and challenges involved.

Former OIG Healthcare Fraud Investigators with Proven Results in Medicare Audit Defense

Our former OIG healthcare fraud investigators provide Medicare audit defense services for physician practices, pharmacies, hospitals, clinics, laboratories, and other healthcare entities nationwide. As a result of our consultants’ vast government experience, we are extremely well-versed in the rules, process, and procedures that govern Medicare audits. We use our government experience to our clients’ advantage, and we have a proven track record of helping providers and other businesses avoid unnecessary liability and other consequences during (and after) the audit process.

Medicare Audit Defense: What Healthcare Providers and Business Owners Need to Know

Successfully defending against a Medicare audit requires an informed approach. Healthcare providers and business owners need to have a clear understanding of the audit process, the potential outcomes, and their legal rights. When engaged for Medicare audit defense, we walk physicians, pharmacists, executives, and business owners through everything they need to know, and then we get to work quickly putting the framework in place so we can execute an efficient and strategic defense.

Here are some important facts to know if your healthcare practice or business is facing a Medicare audit:

1. You Need to Know What Entity is Conducting the Audit

While federal agencies like the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) conduct Medicare audits, so do private contractors. The Centers for Medicare and Medicaid Services (CMS) engage private companies to conduct Medicare audits on a “fee-for-service” basis. This means that these companies have a financial incentive to uncover overpayments only—and this significantly influences the audit process.

But, while dealing with a MAC, RAC, or UPIC presents some unique challenges, so does dealing with the federal government. If the OIG (or another federal agency) is conducting the audit, this requires a particular approach as well. So, identifying the entity that is auditing your practice or business is the first step toward an effective defense.

2. A Medicare Audit Should Not Be a Unilateral Process

Too often, healthcare providers and business owners make the mistake of allowing auditors to examine their billing records without oversight. This invites a host of problems, and it can lead to scrutiny of billings (and other practices) that shouldn’t be subject to review. A Medicare audit should not be a unilateral process. Instead, providers and businesses that are facing audits should take a proactive approach to their defense, and they should engage a team of expert Medicare billing and audit defense consultants to deal with the audit for them.

3. Medicare Audits Can (and Frequently Do) Lead to Unwarranted Consequences

While auditing plays an important role in preventing fraud, waste, and abuse in the Medicare system, it also frequently leads to unwarranted consequences for legitimate healthcare providers and other businesses. The unfortunate reality is that even many auditors do not have a comprehensive and accurate understanding of the extraordinarily complex Medicare billing rules and regulations. Additionally, CMS’s “fee-for-service” audit program incentivizes private contractors to pursue maximum recoupments, and this unfortunately also leads to unjustified audit results in some cases.

All of this means that healthcare providers and business owners cannot trust the audit process—and they cannot simply allow a Medicare audit to run its course. Instead, they need to scrutinize auditors’ methods and conclusions, and they need to proactively address any issues that have the potential to lead to unwarranted or unnecessary consequences.

4. The Consequences of a Medicare Audit Can Be Significant

Speaking of consequences, the consequences of a Medicare audit can be significant. Under the Medicare billing regulations and CMS’s “fee-for-service” audit rules, findings of improper billings can lead to:

• Recoupment demands
• Denial of pending claims
• Prepayment review of future Medicare billings
• Additional fines and financial penalties
• Temporary or permanent exclusion from Medicare

If auditors conclude that a provider’s billing violations (or alleged billing violations) rise to the level of healthcare fraud, they can also refer providers and businesses for investigation. Investigations conducted by the OIG, U.S. Department of Justice (DOJ), and other federal agencies can potentially lead to civil or criminal charges. Some examples of audit findings that may trigger a referral include:

• Billing for “medically-unnecessary” services (as defined by the Medicare billing regulations)
• Billing for “medically-unnecessary” equipment or supplies
• Billing for services not actually rendered (auditors refer to this as “phantom billing”)
• Double-billing Medicare and other payors (whether private or public)
• Upcoding, unbundling, and other common billing and coding errors

5. Targeted Providers and Businesses Can (and Should) Take Control of the Process

At Corporate Investigation Consulting, we take control of the Medicare audit process for our clients. We intervene in the process immediately, establish lines of communication, and make clear that we will be scrutinizing all aspects of the audit. When auditors overreach or make mistakes, we address these issues right away, and we keep the audit on a narrow track so that it gets resolved as quickly and favorably as possible.

Our Process for Medicare Audit Defense

While facing a Medicare audit can be dangerous, this doesn’t have to be the case. At Corporate Investigation Consulting, we take a systematic approach to defending healthcare providers and businesses nationwide during the audit process. In all scenarios, our process involves:

• Intervening in the Audit – We intervene in our clients’ Medicare audits immediately. We let the auditors know that all communications need to run through us, and we take the burden of dealing with the audit off of our clients’ shoulders.
• Examining the Relevant Billing Records – We promptly review our clients’ relevant billing records to assess their risk in the audit. We then build custom-tailored audit defense strategies based on the circumstances at hand.
• Controlling the Auditors’ Access to Information – Throughout the process, we strictly control the auditors’ access to information. We ensure that they do not talk to internal personnel without authorization, and we ensure that they do not obtain records that are ineligible for review.
• Scrutinizing the Auditors’ Methods, Practices, and Conclusions – We scrutinize the auditors’ methods and practices throughout the process as well. When they misapply the Medicare billing regulations or calculate Medicare’s liability incorrectly, we address this right away.
• Demonstrating Medicare Billing Compliance and Proactively Resolving Issues as Necessary – When it makes sense to do so, we take steps to affirmatively demonstrate our clients’ adherence to an effective Medicare billing compliance program. When it is necessary to do so, we work to resolve issues proactively before they lead to unnecessary outcomes.

FAQs: Avoiding Unnecessary Consequences During a Medicare Audit

Contact Us for a Complimentary Initial Consultation Today

Are you facing a Medicare audit? If so, we encourage you to contact us promptly to learn more about how we can help. To arrange a complimentary initial consultation with a Medicare audit defense consultant at Corporate Investigation Consulting, please call 888-352-9324 or tell us how we can reach you online now.

Healthcare Providers Facing DOL Audits Need to Defend Themselves Effectively

For healthcare providers that treat federal employees, reimbursements from the U.S. Department of Labor (DOL) can be a critical source of revenue. But, accepting payment from the DOL also opens healthcare providers up to scrutiny. The DOL regularly audits healthcare providers that bill for reimbursements, and these audits can present significant risks for providers that aren’t careful.

DOL Audits Present Significant Risks for Healthcare Providers that Treat Federal Employees

Similar to all other types of healthcare billing audits, DOL audits require a strategic and effective defense. Failing to defend against a DOL audit can lead not only to recoupment demands, but other consequences as well. If an audit uncovers significant overpayments, the DOL can deny pending claims and institute prepayment review, or it can simply exclude providers from billing for reimbursements in the future.

If the DOL’s billing auditors determine that a provider’s errors rise to the level of fraud, a DOL audit can also trigger a civil or criminal healthcare fraud investigation. The consequences of these inquiries can be even more severe—including substantial fines and prison time in some cases. As a result, healthcare providers cannot afford to take their DOL audits lightly, but instead must engage an experienced outside consulting firm to deal with the DOL on their behalf.

Our DOL Audit Defense Services are Backed By Centuries of Relevant Experience

At Corporate Investigation Consulting, we provide DOL audit defense services backed by centuries of relevant experience. Our team includes several former federal healthcare fraud investigators who spent decades examining providers’ billing records for the government before moving into the private sector. As a result of this experience, we are intimately familiar not only with the DOL billing rules, but also with how the DOL enforces these rules. We know the issues that can lead to problems for healthcare providers during DOL audits, and we know the strategies providers can use to overcome them.

What To Expect During a DOL Audit

When facing a DOL audit, it is important to know what to expect. This will allow you to make informed decisions, and it will allow you to proactively manage your practice’s risk so that you do not face unwarranted recoupment liability (or other consequences) unfairly or unnecessarily.

Here is what you can expect during your healthcare practice’s DOL audit:

• The DOL Will Conduct an Exhaustive Billing Review – DOL audits are comprehensive, exhaustive, and time-intensive endeavors. The DOL’s auditors will seek to scrutinize a substantial volume of your practice’s billing records, and you will need to be careful to ensure that only billings that are eligible for review get reviewed.
• The DOL Will Expect to See Proof of Compliance – Beyond examining your practice’s billing records, the DOL will also want to see your practice’s compliance documentation. If you do not have the documentation needed to prove compliance, this will create significant challenges during the DOL audit process.
• Lack of Proof Will Be Deemed Evidence of Noncompliance – If you are unable to prove compliance, this will be deemed evidence of noncompliance. This is one of several reasons why healthcare providers cannot ignore the audit process. Providers must be prepared to affirmatively demonstrate compliance, and they must be able to demonstrate compliance effectively in order to avoid unnecessary consequences.
• The DOL’s Auditors Might Make Mistakes – When auditing your practice’s billing records, the DOL’s auditors might make mistakes. This is another reason for providers to play an active role in their DOL audits. If auditors incorrectly calculate the reimbursements your practice was entitled to receive, this could lead to unjustified recoupment demands.
• The DOL’s Auditors Will Seek to Impose Recoupment Liability – The purpose of a DOL audit is to uncover overpayments; and, to show that their efforts are worthwhile, auditors will seek to impose recoupment liability—unless you intervene. As a result, healthcare providers cannot take a passive approach, but must instead focus on executing a proactive defense.
• The DOL’s Auditors May Impose Other Penalties As Well – Along with recoupments, DOL audits can also lead to various other penalties. These include denial of pending claims, prepayment review, and exclusion as noted above. If DOL auditors uncover what they determine to be evidence of intentional billing fraud, they will not hesitate to hand this evidence over to the U.S. Department of Justice (DOJ) for use in a subsequent civil or criminal prosecution.
• You May or May Not Know Why the DOL Reached Its Decision – The DOL audit process can be surprisingly, and unnervingly, opaque. As a result, if auditors impose recoupments or other penalties, you won’t necessarily know why. But, you can avoid this by engaging an outside consulting firm to take control of the process for you.

Why Healthcare Providers Nationwide Choose Us for DOL Audit Defense

When facing a DOL audit, engaging an outside consulting firm is essential for mitigating the risks involved. Here are just some of the reasons why healthcare providers nationwide choose Corporate Investigation Consulting for DOL audit defense:

• We Are a Team of Former Federal Healthcare Fraud Investigators – Several of the members of our DOL audit defense team spent decades investigating healthcare billing fraud for the federal government before joining our firm. As a result, we know how to examine DOL billings from the government’s perspective.
• We Know the DOL Billing Rules Inside and Out – Our extensive experience also means that we know the DOL billing rules inside and out. Unlike consultants at other firms, our experts do not need time to get up to speed.
• We Conduct Comprehensive Internal Billing Reviews to Assess Our Clients’ Risks – One of our first steps with every engagement is to conduct a comprehensive internal billing review. This lets us know where our clients’ risks lie and formulate our defense strategy accordingly.
• We Work Proactively and Strategically to Protect Our Clients – Our goal in every engagement is to protect our client as quickly, quietly, and cost-effectively as possible. This means taking a proactive and strategic approach to dealing with the DOL’s auditors during the audit process.
• We Execute Custom–Tailored Defense Strategies – We don’t take a one-size-fits-all approach to DOL audit defense—because this approach simply doesn’t work. Instead, we develop and execute custom-tailored defense strategies based on our clients’ specific risks and opportunities.
• We Do Not Hesitate to Question the DOL’s Practices When Necessary – When the DOL’s auditors make mistakes, we let them know. We do not hesitate to question the DOL’s practices, and we make sure that mistakes and overreaching do not lead to unwarranted consequences.
• We Have a Proven Record of Success in DOL Audits – Finally, and perhaps most importantly, we have a proven record of success in DOL audits. We have helped healthcare providers across the country not only avoid substantial recoupment liability, but also avoid other penalties and the risk of civil or criminal prosecution.

FAQs: What Healthcare Providers Need to Know About DOL Audit Defense

Request a Complimentary DOL Audit Defense Consultation Today

If you would like to know more about our DOL audit defense services for healthcare providers, please contact us to arrange a complimentary initial consultation. To discuss your practice’s needs with a senior DOL audit defense consultant at Corporate Investigation Consulting in confidence, please call 888-352-9324 or tell us how we can help online now.

Former DEA Agents and Investigators Providing Comprehensive Audit Defense Services

The U.S. Drug Enforcement Administration (DEA) audits registered healthcare providers and pharmacies to assess compliance with the Controlled Substances Act (CSA) and other federal laws and regulations. During these audits, DEA agents thoroughly examine registrants’ books and records, and they examine all aspects of providers’ and pharmacies’ prescription drug practices. While technical violations can lead to administrative consequences, more-serious violations can lead to civil enforcement action—and even criminal prosecution in some cases.

With this in mind, healthcare providers and pharmacies that are facing DEA audits need to execute a coordinated and strategic defense. At Corporate Investigation Consulting, we rely on centuries of relevant experience to assist our clients with this process. Not only do we have extensive experience providing DEA audit defense services, but several of our consultants previously conducted audits and oversaw investigations at the DEA.

We Put Former DEA Agents and Investigators On Your Side

When you are dealing with a DEA audit, experience matters. You need to know what to expect during the process, and you need to be able to anticipate potential outcomes so that you can adjust your defense strategy in real-time. When you choose Corporate Investigation Consulting for your practice’s or pharmacy’s DEA audit, your team will include:

• Kristy Smith, Former DEA Diversion Investigator – Kristy Smith is a former DEA Diversion Investigator who led major audits and investigations for the DEA before joining the private sector. She has extensive knowledge of the DEA’s auditing strategies and methodologies, and she uses this knowledge to help clients favorably resolve their audits as efficiently as possible.
• Roger Bach, Former Executive Assistant to the New York DEA Special Agent-in-Charge – Roger Bach spent more than 30 years working inside the government at the DEA, Office of Inspector General (OIG), and other agencies. He has extensive experience on both sides of federal audits and investigations, with a particular focus on matters involving healthcare providers and pharmacies.
• Dennis Wichern, Former DEA Special Agent-in-Charge – Dennis Wichern is a former Special Agent-in-Charge at the DEA in Chicago. He has more than three decades of federal law enforcement experience; and, during his tenure at the DEA, he supervised more than 600 agents, investigators, attorneys, and staff members while holding primary responsibility for the DEA’s civil and criminal operations in five states.
• James Hunt, Former DEA Special Agent-in-Charge – James Hunt is also a former Special Agent-in-Charge at the DEA. Mr. Hunt spent much of his DEA career in New York, leading the Administration’s largest office and overseeing countless audits and investigations into healthcare providers, pharmacies, and other entities. Before moving to New York, Mr. Hunt also spent time at the DEA’s Miami Field Division and its Special Operations Division in Chantilly, Virginia.

5 Risks for Healthcare Providers and Pharmacies in DEA Audits

Regardless of the circumstances involved, facing a DEA audit presents several substantial risks. Even for healthcare providers and pharmacies that have fully complied with the CSA, the Drug Supply Chain Security Act (DSCSA), the DEA’s electronic prescription regulations, and all other pertinent sources of authority, avoiding unnecessary consequences requires a proactive defense. DEA agents expect to see affirmative proof of compliance; and, if providers and pharmacies are not able to demonstrate their compliance effectively, this alone can lead to an unfavorable outcome. With this in mind, here are five of the main risks involved with facing a DEA audit:

1. Inability to Effectively Assess Compliance

When facing a DEA audit, it is essential to know what (if anything) DEA agents are going to find. This is the only way to build and execute a focused defense strategy. Upon learning of an impending DEA audit, providers and pharmacies should immediately engage an outside consulting firm to assess the efficacy of their DEA compliance programs.

2. Inability to Effectively Demonstrate Compliance

As we mentioned above, during a DEA audit, the inability to effectively demonstrate compliance can be just as dangerous as non-compliance. To avoid unnecessary consequences, providers and pharmacies must be able to use the documentation they have on hand to convince the DEA’s agents that they have consistently adhered to all pertinent statutory and regulatory requirements.

3. Dealing with Inadvertent DEA Compliance Failures

Inadvertent compliance failures are not uncommon. Everyone makes mistakes, and the DEA will allow a certain amount of grace when warranted by the circumstances. But, mitigating the consequences of inadvertent compliance failures requires a strategic approach informed by extensive experience on both sides of DEA inquiries.

4. Dealing with Personnel Issues

Healthcare providers and pharmacies can also encounter issues during DEA audits if their personnel have disregarded the importance of compliance. Rogue employees are among healthcare providers’ and pharmacies’ greatest risks, and handling situations involving individual employees who have substantially deviated from their compliance programs requires a highly tactical approach.

5. Facing Administrative Penalties (or a Civil or Criminal Referral) Unnecessarily

These risks, among many others, can result in healthcare providers and pharmacies facing administrative penalties (or referrals for civil enforcement action or criminal prosecution) unnecessarily. At Corporate Investigation Consulting, our former agents and investigators rely on centuries of relevant experience to help defend our clients to the fullest extent possible.

5 Keys to Successful DEA Audit Defense

Taking these risks into account, presenting a successful defense during a DEA audit is paramount. Here are five of the key steps we take to help protect our clients:

1. Immediate and Comprehensive DEA Compliance Assessment

When a healthcare provider or pharmacy engages our team for DEA audit defense, we work quickly to conduct a comprehensive DEA compliance assessment. Once we know what we’re working with, we can then tailor our subsequent efforts accordingly.

2. DEA Audit Defense Strategy Formulation

Based on what we learn during our compliance assessment, we will formulate an audit defense strategy that is custom-tailored to the facts at hand. Demonstrating compliance and dealing with instances of non-compliance are two very different scenarios, and each requires a very different approach.

3. DEA Audit Intervention and Defense Execution

When facing a DEA audit, early intervention is key. Our former agents will intervene in the audit promptly, open a constructive dialogue with the DEA’s auditors, and begin executing our defense strategy.

4. Proactive Involvement Throughout the DEA Audit Process

It is important for healthcare providers and pharmacies to play a proactive role throughout the DEA audit process. At Corporate Investigation Consulting, we deal with the DEA every step of the way, and we continuously work to steer our clients’ audits toward favorable resolutions.

5. Targeting a Specific Positive Outcome

When executing a defense strategy, it is important to have a specific positive outcome in mind. Whether this involves avoiding liability entirely (as is often the case) or mitigating the consequences of compliance failures, targeting a specific result allows providers and pharmacies to take control of the process.

FAQs: DEA Audit Defense

Speak with a Former DEA Agent or Investigator in Confidence

If you would like to speak with a former DEA agent or investigator at Corporate Investigation Consulting, we invite you to get in touch. To schedule a confidential initial consultation as soon as possible, please call 866-352-9324 or tell us how we can reach you online today.

Our Former Federal Agents Help Companies Investigate All Types of Employee Theft

Employee theft is an omnipresent concern for businesses in all industries. As far back as 1979, federal estimates put the rate of employee theft as high as 80 percent, and the U.S. Department of Commerce attributed approximately 30 percent of all business failures to “dishonest acts of employees.” Today, not much has changed. Several sources put the rate of employee theft in this same range, and businesses of all sizes can (and frequently do) find themselves in need of employee theft investigation services.

At Corporate Investigation Consulting, conducting internal investigations is our specialty. This includes conducting investigations into all types of employee theft. If you are concerned that one (or more) of your company’s employees have stolen company assets or engaged in any other form of theft or fraud, our former federal agents can gather the intelligence you need to make informed decisions, impose appropriate discipline, and take legal action if warranted.

Types of Employee Theft Investigations We Handle

While employee theft predominantly involved cash and inventory theft 40 years ago, the world is much different today. These are still very real concerns for many businesses, but they are no longer the primary concerns for most companies. Like most other aspects of modern commerce, employee theft is increasingly becoming an online endeavor. Employees are using sophisticated (or not-so-sophisticated) methods to divert their employers’ funds or steal sensitive data, and in doing so they are causing their employers significant financial—and in some cases reputational—harm.

We handle all types of employee theft investigations on behalf of companies nationwide. Our corporate investigators work with companies on the ground and track digital transactions around the world. Some examples of the types of employee theft investigations we conduct for our clients include:

Equipment and Supplies Theft

Theft of company equipment and supplies is many individuals’ first foray into unlawfully taking advantage of the access they have as employees. If your company’s employees are stealing supplies, stealing equipment, or using equipment for unauthorized personal purposes (or competing business purposes), we can investigate and collect the evidence you need to take appropriate responsive action.

Merchandise and Inventory Theft

Merchandise and inventory theft are significant sources of financial loss for many companies as well. In some cases, employees will try to cover up their merchandise and inventory theft by altering purchasing records or creating fake customer accounts. In others, they will make the (flawed) assumption that no one will notice or care if a few items go missing. But, merchandise and inventory theft can cost companies millions of dollars a year—and these are losses that companies can (and should) prevent through investigation and enforcement.

Cash Theft

For retail businesses that deal in cash, cash theft is also a significant concern. Misreporting sales, claiming customer theft, and falsely reporting customer refunds are just a few examples of ways employees may try to get away with stealing cash from their employers. While cash theft can be more difficult than some other types of theft to track, our former federal agents have the knowledge, experience, and resources required to investigate these cases effectively.

Embezzlement

Embezzlement is a specific type of employee theft that involves taking advantage of an employee’s position of trust within the company. While some cases of embezzlement involve new employees, a surprising number of embezzlement cases involve individuals in finance and other departments who have been with their employers for years, if not decades. We have significant experience handling embezzlement cases not only as corporate investigators, but previously as federal agents with the Federal Bureau of Investigation (FBI) and other agencies as well.

Financial Fraud

Along with embezzlement, employees can commit theft through various other forms of financial fraud as well. This includes setting up hidden accounts, diverting corporate funds to private accounts, splitting payments, establishing themselves as vendors, payroll fraud, and various other illicit activities. We rely on our forensic accounting capabilities to help our clients uncover and address their employees’ theft in these cases.

Time Theft

Time theft is another common form of employee theft that costs many employers millions of dollars per year. Common forms of time theft include misrepresenting employees’ hours worked, having coworkers “punch in” for employees who are not present, taking extended breaks, and performing personal tasks on company time. Within companies, employees can develop a culture of time theft, and this form of theft can become a pervasive issue that requires a broad-scale investigation and strategically coordinated response.

Data Theft

Employee data theft has quietly become one of the greatest risks to many companies. This includes theft of customers’ and patients’ personal, financial, and health information as well as theft of companies’ proprietary data and intellectual property. Instances of data theft require a prompt response, as limiting further dissemination (or sale) of the stolen data can be crucial for mitigating the costs to the company.

Employee Theft Investigations: Our Process

Like all types of corporate investigations, employee theft investigations are most effective (and often only effective) when conducted in an organized, structured, and strategic manner. With this in mind, our process for conducting employee theft investigations involves:

• Preserving Critical Evidence – Oftentimes, it will be necessary to preserve critical evidence before initiating the investigative process. This can be essential, for example, if there is a risk that the employee (or employees) involved will attempt to destroy or erase files to cover up their theft.
• Establishing the Investigation Team – We work closely with our clients to carefully select the members of each investigation team. Our former federal agents will work closely with the appropriate personnel from your company to identify all pertinent sources of information.
• Collecting Data – Our investigators will work quickly to collect the data we need to examine the theft at issue. The specific data we need will depend on the nature of the theft, its timing and duration, and various other factors.
• Conducting Forensics – As warranted, we also conduct forensic investigations to examine our clients’ inventories, equipment assets, and books and records. We also tailor our forensic investigation to the nature of the theft at issue.
• Conducting Interviews – In many cases, investigating employee theft will require employee interviews. This may or may not include interviewing the employee (or employees) suspected of theft.
• Examining the Evidence in Real-Time – As we work through the investigative process, we examine the evidence in real-time. We keep our clients fully informed so that they can make critical decisions as soon as possible.
• Working with Our Client – Our former federal agents work alongside our clients’ executives and key stakeholders throughout our employee theft investigations. While some consulting firms draft an investigation report and then leave it up to the company to decide what to do next, we work with our clients as partners to help them make the right decisions.

FAQs: Investigating and Recovering Losses from Employee Theft

Contact the Former Federal Agents at Corporate Investigation Consulting

If your company needs to conduct an employee theft investigation, we encourage you to contact us promptly for more information. Call 866-352-9324 or contact us online for a confidential consultation.

Former Federal Agents with Over 100 Years’ Experience Investigating Fraud

As a business owner or corporate executive, you have a zero-tolerance policy for fraud. You care too much about your company’s reputation, and you expect your employees to act in your company’s best interests at all times.

Unfortunately, employees don’t always do the right thing. As a result, fraud is a major—and persistent—concern for companies in all industries. This includes both fraud perpetrated against the company and fraud perpetrated against third parties or the market at large. Fraud costs companies billions of dollars annually, including both direct losses from fraud and liability for civil and criminal penalties.

Our Former Federal Agents Know How To Identify, Uncover, and Dispute Allegations of Fraud

At Corporate Investigation Consulting, our former federal agents rely on well over a century of combined experience to identify, uncover, and dispute allegations of all forms of fraud. We routinely conduct internal investigations in response to instances of fraud committed against our clients as well as external allegations of fraud. In both scenarios, it is critical that business owners and corporate executives make strategic decisions based on complete and accurate information. Our investigators ensure that our clients have the intelligence they need to make the right decisions with their companies’ best interests in mind.

Types of Fraud Investigations We Handle

We handle fraud investigations on behalf of public and private companies nationwide. This includes investigations focused on (i) uncovering fraud committed against the company and (ii) responding to external allegations of corporate fraud.

1. Uncovering Fraud Committed Against the Company

If you are concerned that a client, customer, employee, or vendor has defrauded your company (or is engaged in an ongoing fraud scheme), it is important that you engage an outside firm to investigate the fraud immediately. At Corporate Investigation Consulting, we investigate all forms of fraud committed against our corporate clients, including:

Client and Customer Fraud

Clients and customers can (and frequently do) engage in various forms of fraud. This includes everything from underreporting service utilization and exceeding the limits on software licenses to underpaying and fraudulent disputing charges on their invoices. Even if you aren’t necessarily interested in pursuing legal action against one of your company’s clients or customers, documenting the fraud and handling the issue informally may be an appropriate—and necessary—course of action.

Data Fraud and Theft

We handle data fraud and theft investigations involving both internal and external bad actors. Whether an employee is improperly using sensitive data or you need to conduct a cybersecurity breach investigation, we can uncover and prove the source of the issue so that your company can take disciplinary or legal action as warranted.

Embezzlement

Embezzlement is far more common than most business owners and corporate executives realize. If you have reason to believe that an employee is embezzling from your company’s accounts, conducting an internal corporate fraud investigation is the first step toward taking appropriate responsive action.

Equipment and Vehicle Misuse

Use of company equipment and vehicles for unauthorized personal purposes or competing business purposes is another all-too-common form of employee fraud. We have significant experience investigating this form of fraud as well, and we can use forensic investigation, data analysis, and other means to determine if one or more of your company’s employees are engaging in fraudulent misuse of corporate assets.

Financial Fraud

Financial fraud includes embezzlement, misuse of company credit cards, unauthorized use of corporate accounts, falsifying corporate transactions, and all other forms of illicit access to corporate funds. If one of your company’s employees is engaged in financial fraud (or has engaged in financial fraud), we can gather the digital or other evidence needed to prove it and justify your company’s next steps.

Inventory Theft

Inventory theft is another common type of corporate fraud that requires a prompt and thorough internal investigation. While employees often think they can get away with inventory theft, we have several methods we can use to prove inventory theft and allow your company to hold the employee (or employees) involved accountable.

Vendor Fraud

We also help companies take action against vendor fraud. If a vendor is overcharging your company or delivering substandard goods or services, you can (and should) take the vendor to task. But, before doing so, you need to ensure that your company is in the right, and this means that you need incontrovertible evidence of the fraud.

2. Investigating External Allegations of Corporate Fraud

When facing external allegations of corporate fraud, one of the first steps toward executing a strategic defense is to conduct an internal fraud investigation. Once you know the facts—whether they are in your company’s favor or not—you can use this information to make strategic decisions about how to respond. We conduct internal fraud investigations on behalf of companies facing external audits, investigations, and litigation involving allegations of:

Bankruptcy Fraud

While filing for bankruptcy can be an effective way to reorganize a company’s debts and restore its financial stability, allegations of bankruptcy fraud can derail the process. We help companies deal with allegations of fraudulent transfers, preferential transfers, concealment of corporate assets, and other statutory violations.

Billing Fraud

We help companies conduct internal investigations in response to external allegations of billing fraud. This includes allegations from government payors and benefit programs (i.e., Medicare and Medicaid), insurance companies, and other entities and individuals.

Contract Fraud

We help companies respond to allegations of contract fraud under commercial, consumer, and government contracts. Whether your company is being accused of overbilling the government or failing to fulfill its warranty obligations, we can assist with gathering the information your company needs to respond appropriately.

Corporate Fraud

Corporate fraud can take many different forms, and defending against allegations of corporate fraud can require a broad range of strategies. In all cases, however, the first step toward executing an effective defense is to gain a comprehensive understanding of the relevant facts and circumstances.

Lender and Equity Investor Fraud

Companies can face fraud allegations from their lenders and equity investors in various capacities. This includes fraud in the inducement (i.e., making fraudulent misrepresentations to secure access to capital) and fraud in relation to non-payment of dividends or amounts due. If a lender or investor is accusing your company of fraud, our former federal agents can assist with collecting the internal data needed to respond to the allegations appropriately.

Insurance Fraud

Our former federal agents can also assist with responding to allegations of insurance fraud. We conduct internal investigations related to allegations of both fraudulently procuring coverage and filing fraudulent insurance claims.

Securities Fraud

We conduct internal fraud investigations for public and private companies facing securities fraud allegations as well. This includes civil and criminal allegations in U.S. Securities and Exchange Commission (SEC) investigations, U.S. Department of Justice (DOJ) prosecutions, and commercial litigation. We also conduct internal investigations on behalf of broker-dealer and investment advisory firms facing allegations of securities fraud.

FAQs: Conducting an Internal Fraud Investigation

Discuss Your Company’s Needs in Confidence

If you would like more information about our internal fraud investigation services, we invite you to get in touch. Please call 866-352-9324 or contact us online to speak with a senior investigator and former federal agent at Corporate Investigation Consulting today.