Mistakes are inevitable, but it is what we do next that defines our character…

- Kameron Gifford, CPC

On February 11, 2013 Departments of Justice and Health and Human Services announced record-breaking recoveries of 4.2 billion in CY 2012. http://www.hhs.gov/news/press/2013pres/02/20130211a.html

This “joint effort to combat healthcare fraud” does not appear to be going away anytime soon.  In fact, I believe the only way that we can stop the governments intrusion into healthcare is to create accountability within the industry. How long do you think audits would continue if they revealed compliant operating and billing practices? Without recoveries the funding would stop.

There are seven things that will destroy us: Wealth without work; Pleasure without conscience; Knowledge without character; Religion without sacrifice; Politics without principle; Science without humanity; Business without ethics.
- Mahatma Gandhi

If you practice medicine, run a hospital, or manage a practice, you are intimately aware that even the best people can make mistakes. Have you ever spent days looking for a missing chart or come across a critical lab that had been “misplaced”? Or maybe you received a list of medical records to be audit by an insurance company and 1 of the dictations has “disappeared” or better yet, the patient never came in that day. Was this a malicious act by your front office staff or biller? Probably not, but it is what you do at that exact moment of discovery that will determine the potential of a negative outcome.

In my experiences it a combination of blunt honesty and a sincere desire to “make it right” that yields the greatest possible outcomes. We are human and mistakes are inevitable.

With increasing oversight and increasing expectations of due diligence, all eyes will be on the healthcare industry. What can we do if we have received a letter relating to an investigation or audit? What if we have recently settled a claim of “upcoding or over-billing”?

Take actions to improve. Remember, everything happens for a reason. We often suffer through misfortune before we can reach the high points in life. View this as an opportunity to show the world your inner strength and resilience. Create a stronger corporate culture, invest in education, and continue to strive every day to do something more than you did yesterday.

If you have not yet been the target of an audit, prepare now, because you will be one day. Audit yourselves just as the OIG, Medicare or Medicaid or a commercial payor might. Our best offense is a great defense. Create transparent processes, encourage conversations between your entire team, and get a second opinion. A fresh perspective may be your most valuable resource.