Hi, I am an Auditor and I am Here to Help

person in suit having a discussion

The only thing possibly scarier than those words is – “I am from the IRS and I am here to help.”  Well, it doesn’t have to be that way. Auditors can fall into many stereotypes at times. What’s the first image that comes to mind for you when you hear the word, “auditor”? An audit is a very important part of an effective compliance program. In fact, it is one of the seven elements.

The purpose of a healthcare compliance audit is four fold:
1. To prove you are in compliance
2. To show areas where they can be improved
3. To cement into place best practices that you have implemented and to make your organization’s compliance plan even better, and
4. To be ready to pass an outside party/regulator official audit.

In healthcare, the importance of an audit has never been more in the spotlight. In fact in 2015, the OIG issued “Guidance on the Responsibility and Accountability for Health Care Governing Boards.” This was published in conjunction with the American Healthcare Lawyers Association (AHLA) and the Association of Healthcare Internal Auditors (AHLA) as well as the Health Care Compliance Association (HCCA).  The purpose of the Guidance was to reaffirm the role of the board in oversight and to ensure their compliance. The Guidance suggests that the board’s elicit outside experts on areas regarding billing, possible security breaches and/or government investigations, as well as complying with OIG Corporate Integrity Agreements (CIA).

The gist of the Guidance is to ensure the Board is aware of compliance training, program effectiveness, areas of non-compliance and governance.  An audit is one of the processes to advise and inform the Board of Internal Operations and Compliance.

But an audit must be coupled with a corrective action plan for potential risk areas. The audit can provide great insight, as well as, present hotspots that need to be redressed. In some cases,  the audit results may uncover a violation of law and thus require a self-disclosure to the OIG or result in over payments to CMS.

Our series of blogs this month will provide you with the following tactical solutions:

1.   How to conduct an effective health care audit

2.  How to appropriately respond and pivot to audit findings

3.  Checklist of items every auditor expects you to know

So, with and audit you can:  Keep Calm, you got your Compliance On!

Check out last month’s blogs:
Compliance Training: Look at the Outcomes!
CHIRP:  Q-3 Review and Lessons learned
If you haven’t heard yet! On Demand Exclusion Data Workshop Available
Onboarding an Employee – Steps to Ensure a Compliant Culture

Michael Rosen, Esq.

Written by Michael Rosen, ESQ
ProviderTrust Co-Founder,

Michael brings over 20 years of experience founding and leading risk mitigation businesses, receiving numerous accolades such as: Inc Magazine’s Inc 500 Award and Nashville Chamber of Commerce Small Business of the Year
Connect with Michael on Linkedin

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