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Practical considerations for conducting effective billing audits.

Robert F Bacon¹

¹Office of Billing Compliance, University of Pennsylvania, Health System, Philadelphia, Pennsylvania, USA. baconb@uphs.upenn.edu

Healthcare Financial Management : Journal of the Healthcare Financial Management Association

|April 20, 2002

Summary

This summary is machine-generated.

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Healthcare providers must ensure regulatory compliance to avoid fraud and abuse investigations. Proactive audits help uncover and correct potential billing issues, preventing penalties like those faced by the University of Pennsylvania.

Area of Science:

Healthcare compliance
Medical billing regulations
Fraud and abuse prevention

Background:

Healthcare organizations face increased scrutiny from the HHS Office of Inspector General (OIG) regarding fraud and abuse.
Non-compliance can lead to significant financial penalties and corporate integrity agreements.

Purpose of the Study:

To highlight the importance of regulatory compliance in healthcare billing.
To share lessons learned from a specific case of OIG investigation and settlement.

Main Methods:

Review of a case involving the Clinical Practices of the University of Pennsylvania (CPUP) and an OIG audit.
Analysis of the settlement terms, including financial penalties and a corporate integrity agreement.

Main Results:

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CPUP entered into a settlement with significant financial penalties and a five-year corporate integrity agreement following an OIG audit.
The case underscores the risks associated with non-compliance in Medicare billing.

Conclusions:

Providers should proactively conduct internal audits to identify and rectify potential billing compliance issues.
Learning from past cases can help other organizations maintain regulatory adherence and avoid penalties.