Compliance Audit

What is a compliance audit? 

Healthcare compliance audits are critical to evaluate how a company or entity complies with laws and regulations. An audit is a series of inspections and checks performed by objective individuals to ensure that the company or health care entity is in compliance with its policies and is running correctly. Essentially – is the company doing what their policies say they do? 

The audit is performed from an objective viewpoint to identify weak spots within procedures, processes, and policies. Objectivity is needed to move forward in progress and critical thinking to improve the level of care and the compliance that a company has to the law, its policies, and by-laws. 

An audit is an outward-facing and ongoing process that is imperative for improving the healthcare compliance plan.

 

How do compliance audits work?

Each compliance audit will look into and evaluate how effectively the company’s policies are being adhered to. Typically, a healthcare compliance officer will conduct the audit. 

After the audit is complete, there should be an evaluation and recommendations to improve the issues within the healthcare entity. The list will include ways to revise the company’s procedures for closer adherence to policies. Formal audits performed by government entities may also include penalties against the company. 

 

Common Penalties for healthcare compliance audits?

Penalties can come from any direction – especially in Healthcare. Common penalties could be anything from a Health Insurance Portability and Accountability Act (HIPAA) violation to cybersecurity and even fraud. Common risks that could result in a penalty include: 

  • Identity theft – with online records, patients’ personal information is at risk 
  • Payment Issues – credit card fraud has become a rising issue in compliance audits 

 

Difference between monitoring and auditing? 

The difference between monitoring and auditing is a fine line.

Monitoring is continuous in order to identify risk areas and make sure everyone is complying with proper procedures and by-laws. Monitoring can be conducted without any outside help utilizing internal managers and/or compliance officers. Preventative internal audits benefit organizations by highlighting weaknesses and initiating change and avoiding penalties from a future formal audit.

Auditing is performed to evaluate and test whether or not policies are effective. Internal audits can be conducted objectively by the healthcare compliance officer and help identify safety problems, proactively guide patient safety, and inform healthcare administrators on the current status of patient safety within their organization. External audits are most commonly conducted for accreditation and certification and can be distinguished from internal audits by the use of eternal standards and collaboration from individuals outside of the organization. Audits are an essential component to compliance. 

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