Recently one of our hospital clients had a Third Party Audit Firm sneak a request for records past a new person. In my article titled “Your Losses Begin in Medical Records” you’ll see that releasing medical records needs to be carefully considered. In any case these records were released under the false pretense of a quality review when in fact the review was a one sided desk audit followed by a request for a $38,000 refund. I immediately contacted the firm and explained that they had violated our the facilities audit policy. This brought little to no response so I told the individual on the phone we would do the following:
1. Not honor the results as they were gathered in direct violation of our policy
2. block all audit activity that was currently underway with this firm and this location
3. If no response within five days we would permanently block access to this third party firm for life at this site for misconduct
4. We would notify the payer that they would need to find a different third party firm for auditing at this site because theirs had been banned for violation of our audit policy
By the fourth business day the Third Party Firm rescinded their results. I asked for e-mail confirmation which I got promptly. As an Internal Auditor you take a lot of beatings in the community and some are rightly so, but much of what you do is not appreciated. I share today’s story to encourage my fellow auditors to play fair and put up a vigorous defense.
Medlinks provides medical auditing, audit tracking software, and case management remotely.
