Internal Audits Role in Compliance

1
Internal Audits Role in Compliance

• Laurisa Riggan, CPA, CHE
• Childrens Mercy Hospitals and Clinics
• September 26, 2000

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Similar Characteristics

• High Level of Reporting
• Direct Access to Board of Directors
• Independent
• Objective
• Effective Communication Skills

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Program Guidance Elements

• Standards and Procedures
• Program Oversight
• Education and Training
• Communication and Reporting Mechanisms
• Monitoring and Auditing
• Response and Prevention
• Enforcement and Discipline

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Standards and Procedures

• Identify topics and risk areas
• Draft policies and procedures
• Review and comment
• Conduct baseline assessments

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Program Oversight

• Compliance Committee
• Governing Board

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Education and Training

• General Awareness Training
• Policies and Procedures
• High Risk Topics
• Targeted Training

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Communication and Reporting Mechanisms

• Audit work
• Informal Network
• Program Coverage

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Monitoring and Auditing

• Required Audits for CIAs
• Monitor Corrective Action Plans
• Monitor High Risk Activities
• Internal Audits of Compliance Subjects
• Program Effectiveness Assessment

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Annual Audit Plan

• Audit Population
• Risk Assessment
• Staffing Requirements

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Audit Population

• OIG Program Guidance
• OIG Work Plans
• OIG Special Fraud Alerts
• Internally Reported Concerns
• Interviews
• Organizational Chart
• Chart of Accounts

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Risk Assessment

• Quantitative Criteria
• Variance from Budget
• Percent of Assets, Revenue or Expenses
• Qualitative Criteria
• Potential for Fraud or Theft
• Potential for Legal or Public Exposure
• Employee Turnover
• Education/Training Provided in the Area

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Audit Staffing Requirements

• Financial Auditor
• Information Systems Auditor
• Clinical Auditor
• Coding Auditor

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Program Reviewers

• Independent
• Access to resources and information
• Prepare/present written reports
• Identify necessary corrective action

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Assessment Techniques

• Site visits
• Questionnaires
• Personnel interviews
• Record and document reviews
• Trend analyses

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Response and Prevention

• Conduct or Assist in Investigations
• Sample Selection
• Identify Corrective Action Steps

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Enforcement and Discipline

• Personnel File Review
• Assuring consistency in discipline
• Assuring non-retaliation
• Background Investigations
• Maintaining sanctions database
• Conducting periodic reviews

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Contact Information

• Laurisa Riggan, CPA, CHE
• Childrens Mercy Hospitals and Clinics
• Kansas City, MO
• 816-234-3027
• lriggan_at_cmh.edu