Practical considerations for conducting effective billing audits.

Abstract

Healthcare organizations need to ensure that they are in compliance with government regulations, especially with the increased vigilance by the HHS Office of Inspector General (OIG) in investigating fraud and abuse. After an OIG audit of claims submitted to Medicare by its teaching and resident physicians, the Clinical Practices of the University of Pennsylvania (CPUP), Philadelphia, Pennsylvania, entered into a settlement that included significant financial penalties and a five-year corporate integrity agreement. Lessons learned from the experience may be helpful to other providers in ensuring that their billing practices are in regulatory compliance. As a precautionary measure, providers can undertake their own audits, whether routine or focused. Audits can help providers uncover areas of potential abuse and take steps to correct the problems.