Category: OPERATIONS

Highlights of the General Audit Process

Highlights of the General Audit Process General Audit Process

Typically, a letter announcing the intention of an audit is sent to the company.  However, I have experienced where State Agents came directly into a clinic and started the investigation immediately on premises.  In this case, the investigation was based on a complaint issued to the State Medicaid agency.  Having Federal and State Agents come […]

Ways a Health Plan Audit Can Be Initiated

Ways a Health Plan Audit Can Be Initiated Health Plan Audit

There are several ways that a Health Plan audit can be initiated: As a result of pre-delegation audit and annual audit findings From a delegation/contractual standpoint, there can be Key Performance Indicators (KPIs) that must be met for a health plan to remain in compliance with the Centers for Medicare and Medicaid Services (CMS).  For […]

US Department of Labor announces enforcement, effort for focused inspections in hospitals, nursing care facilities treating COVID-19 patients

US Department of Labor announces enforcement, effort for focused inspections in hospitals, nursing care facilities treating COVID-19 patients

For two years, millions of the nation’s healthcare workers have been battling the coronavirus. Many have endangered themselves as they care for those who contract COVID-19 while working in high-risk settings that expose themselves and their families.