Five simple tips to help healthcare organizations prevent fraud

by Elizabeth Stepp, senior counsel at Oberheiden Law Group, in Dallas

It’s impossible to calculate the amount of healthcare fraud that exists, as much of it slips under the radar. However, healthcare fraud poses a serious problem, putting the health and welfare of beneficiaries at risk while costing taxpayers billions of dollars.

Preventing healthcare fraud and abuse is challenging, especially for hospitals, hospices, and other similar organizations. While there are a lot of honest and well-intentioned healthcare providers, there are quite a few perpetrators?ranging from street criminals to large companies. As such, owners of healthcare organizations need to be on their guard at all times. After all, allegations of fraud and abuse against low-level or top brass employees can affect the reputation of any healthcare organization.

But if you’re the owner of a small or large healthcare organization, don’t let this worry you. The following are some tips to help you prevent your organization’s reputation from taking a hit, and to avoid costly lawsuits.

Perform background checks before hiring

Pre-employment screening for employees, as well as contingent or temporary workers, is a common best practice for healthcare organizations. That being said, not all organizations have the time and resources to perform thorough background checks. Add to this a shortage of quality caregivers plus an increase in the number of patients, and employers find it easy to rely on trust instead of facts.

Since a single scam artist can taint your organization’s reputation, avoid employing or hiring individuals just because they appear to be trustworthy. Make sure pre-employment background checks include the following:

• Education verification: Verify training and accreditation.
• Employment verification: Crosscheck length of employment, position, and performance with previous companies. Note reasons for leaving and analyze gaps in employment history.
• Record verification: Ensure that civil records are clean and confirm that there are no criminal records.

Additionally, check personal references, verify Social Security numbers, and have individuals undergo drug tests.

Have policies and procedures in place

Formalized policies and procedures promote regulatory compliance and workplace safety, and above all guarantee safe and quality patient care. Healthcare organizations also need to have policies and procedures in place to safeguard protected information. Start with defining access and authorization controls, and separate duties in order to reduce opportunities of fraud.

Make sure that policies and procedures are up-to-date and well written, so as to reduce practice variability. Practice that varies from one person to another can lead to sub-standard care and reliance on memory, which in turn can cause errors and oversights. Apart from this, organizations should have a defined set of internal controls to produce accurate financial reports, help comply with laws and regulations, oversee asset protection, and so on.

If you’re not sure about which policies to implement, getting in touch with a healthcare fraud defense attorney will be helpful. These lawyers can defend your case, and they know what it takes to prevent becoming a victim of fraud.

Perform audits regularly

Accurate and complete clinical documentation is important if you want to provide quality healthcare. The best way to improve documentation, and the care that your organization provides, is to conduct regular medical audits. Medical audits can also improve the financial health of your organization, and determine areas that need corrections and improvements.

Ensure that medical auditing and monitoring in your healthcare organizations is:

• A regular and ongoing process
• Conducted by qualified professionals who lay emphasis on government enforcement actions and ensure compliance with internal, state, and federal rules and regulations
• Performed by keeping senior officials and board members in the loop

Protect data

For healthcare organizations, protecting data can mean reducing the number of emergent care cases, improving patient outcomes, providing better oversight and care, and increasing revenue. This makes it necessary for all healthcare organizations?big and small?to protect data. That being said, a lot of small- and mid-sized healthcare organizations think spending on data protection is pointless, as even organizations that take the appropriate steps are attacked by fraudsters.

Sure, data breaches keep happening. But, if you do what’s right, you can definitely protect your organization from being an easy target?and healthcare abusers like easy targets.

Here are some things to keep in mind:

• Dumping data in the trash can gives dumpster divers an opportunity to steal and sell private data. Make a point to shred all data before it is discarded.
• Conduct a risk assessment in accordance with government regulations to help you review security policies, identify threats posed to your organization, and expose system vulnerabilities.
• Remind employees to keep a watchful eye on data and to never leave electronic devices or records unattended.
• Encryption technology known as SSL, or Secure Socket Layer, can prevent data breaches.
• Keep a note of who can access records and manage user identities. Also, allow employees access to information that is pertinent to their position.
• Use complex passwords and two-factor authentication where possible.
• Have a guest wireless network that’s separate from the main corporate network to offer additional protection.
• Get in touch with a cloud vendor or a local security firm to host information systems. Clarify if you’ll be paying for a suite of services or just certain parts, such as encryption or threat management.
• If you can’t afford to spend on data protection, turn to free open-source tools.

Make it easy to report fraud

Reporting fraud and abuse?or any suspicious activity­?should be an easy process. You’ll also have to set up a system so that vendors, employees, and patients and their family members can report abuse anonymously.

Most importantly, take required action on all complaints received. By addressing issues promptly, you’ll instill confidence among your employees and patients.

Protect your healthcare organization today

As an honest healthcare provider, you’d certainly want your healthcare organization to be free of fraud and abuse. Having the right intentions alone won’t be able to help you achieve your goals; you’ll have to take the necessary steps too.

With the information given here, you now know what you need to do to ensure that your healthcare organization is safe. Implement these tips right away, and say goodbye to fraud and abuse!

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