HCCA Survey: Government Auditors Focus More on Not-For-Profit Health Care Providers

Regulators Frequently Conduct Overlapping Audits

MINNEAPOLIS, Aug. 14, 2012 /PRNewswire-USNewswire/ -- Strong and regular scrutiny of the health care industry is not unexpected, however, a survey conducted by the Health Care Compliance Association (HCCA) found that non-profit institutions undergo more government audits than their for-profit counterparts. The survey also found that while larger institutions undergo more audits than smaller ones, the staffing levels to meet the demands of the numerous government audits are considerable across institutions regardless of their size.

Survey respondents reported that 42 percent of non-profits and 25 percent of for-profits were audited by two different government agencies looking at the same problem. The instances of audits from the Health and Human Services (HHS) Office of Civil Rights, HHS Office of Inspector General, Medicare Recovery Audit Contractor (RAC) and Medicaid RAC, as well as Third Party Payers were notably higher than other government-related audits reported. And Medicare RAC audits, implemented to identify improper payments made on claims of health care services provided to Medicare beneficiaries, were the most common, with 47 percent of respondents reporting at least one.

"Anyone who thinks the government is not doing enough to find fraud and abuse ought to look at this survey.  The amount of government and health care resources devoted to these audits is staggering.  And if that was not enough, I would not be surprised if these numbers increased significantly in the next few years," said Health Care Compliance Association Chief Executive Officer Roy Snell.

It is clear from the survey results that the outside audits being conducted by regulators make significant demands upon health care providers, large and small, non-profit and for-profit, but that the burden of audits appears to be falling disproportionately on the not-for profit sector. The sheer number and range of government audits being conducted is likely adding to the amount and complexity of providers' work load.

Additional findings
The average number of audits reported by for-profit health care providers reported was just under four, while not-profits reported an average of six audits occurring in the previous 12 months when the survey was conducted. Not surprisingly, larger organizations, those with 5,000 or more employees, were more likely to have an audit; 76 percent of larger organizations reported at least one Medicare RAC compared to 30 percent of organizations with 250 employees or less.  

Centers for Medicare and Medicaid Comprehensive Error Rate Testing audits, conducted to measure improper payments in the Medicare fee-for-service (FFS) program, were common among providers. Here again the survey found that non-profit organizations (53 percent) experienced these audits more often than for-profit organizations (46 percent).

For the complete survey results, click here:
http://www.hcca-info.org/Resources/View/ArticleId/817/Auditing-the-Auditors.aspx

About HCCA
Minneapolis, Minn.-based Health Care Compliance Association is a non-profit professional membership organization comprised of more than 7,700 compliance and ethics professionals. The organizations exist to champion ethical practices and compliance standards, and to provide educational and training resources for ethics and compliance professionals and others who share these principles. Visit HCCA on the Web at www.hcca-info.org or call toll-free: 888/580-8373. 

SOURCE Health Care Compliance Association