Angela Mattie, associate professor of management and chair of health care management and organizational leadership in the School of Business at Quinnipiac University, was quoted in American Medical News about how physicians can prepare for Medicaid-related audits and payment investigations.
The federal government has stepped up its scrutiny of claims and billing, Mattie told the publication.
“There’s billions of dollars that escape each year from the federal [Dept. of the] Treasury due to upcoding and duplicate billing,” she said. “Sometimes it’s just haphazard issues, and sometimes it’s out-and-out fraud. So there’s a general landscape that has a significant focus on auditing and identifying fraud and abuse in the health care system.”
Mattie offered insight on how to help health care providers prepare for a potential investigation situation:
- Have a payment compliance program in place.
- Designate someone as a compliance officer or create a compliance committee.
- Have set compliance policies and procedures.
- Train and educate your staff.
- Make sure procedures are in place to prevent inappropriate coding and billing.
- Conduct self-auditing and monitoring procedures on a regular basis.
- Devise a method either to self-report improper payments or to take corrective actions based on what is found.
- Enforce disciplinary standards.
- Lead by example and conduct an ethical workplace.