Not-for-profit healthcare organizations face greater scrutiny from government audits than their for-profit counterparts, according to a Health Care Compliance Association survey
Not-for-profits reported undergoing an average of six audits compared with four by for-profit healthcare providers in a 12-month period. Larger companies underwent more audits, as 76% of organizations with 5,000 or more employees reported at least one Medicare recovery audit-contractor review versus 30% of organizations with 250 employees or fewer. Medicare RAC reviews were the most common audits, with 47% of institutions reporting at least one.
The survey, “Auditing the Auditors,” studies regulatory review practices and was published this month by Minneapolis-based HCCA. Respondents were solicited in April via a Web-based survey.
“Anyone who thinks the government is not doing enough to find fraud and abuse ought to look at this survey,” HCCA CEO Roy Snell said in a news release.
“The amount of government and healthcare 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.”
The results also show a problem with redundant audits, as 42% of not-for-profits and 25% of for-profits have reported that two governmental agencies have audited them pertaining to the same issue during the course of 24 months. Researchers say inquiries—from HHS' Office of Civil Rights, HHS' Office of Inspector General, Medicare and Medicaid RACs, and third-party payers—were notably higher than other governmental audits.
“Healthcare providers of all stripes are undergoing an ongoing load of regulatory audits, but what's notable is that the scrutiny does not appear to be distributed evenly,” according to the survey's executive summary.