Industry Insights

IntegraReport – Offering Value for Health Care Organizations

March 2014
Author:  Aaron Rickard

Aaron Rickard

Managing Consultant

Consulting

910 E. St. Louis Street, Suite 200
P.O. Box 1190
Springfield, MO 65801-1190 (65806)

Springfield
417.865.8701

BKD National Health Care Group would like to introduce you to IntegraReporta hotline system designed by BKD’s Forensics & Valuation Services (FVS) team that allows anyone with tips on potential fraud or compliance concerns to anonymously submit information via phone or online.

Setting up a fraud reporting hotline system allows employees, patients and vendors to anonymously expose potential fraudulent or noncompliant behavior occurring within your organization. Consider the following:

  • According to a 2012 study by the Association of Certified Fraud Examiners (ACFE), the health care industry was among the five most common industries victimized by fraud. Some of the top fraud schemes health care organizations experienced were:
    • Billing fraud, including the submission of invoices for fictitious goods or services, inflated invoice amounts or invoices for personal purchases
    • Corruption—the most common scheme in health care is kickbacks to providers for referring patients for certain services, referring patients to certain entities or over-prescribing a particular drug or drug company product in return for financial gain
    • Expense reimbursement by submitting claims for reimbursement of fictitious or inflated business expenses
    • Skimming the revenue cycle, including:
      • Pocketing payments from self-pay patients and not recording the charge
      • Stealing payments on accounts receivable and covering them up with adjustments or write-offs
      • Lapping, in which the employee pockets a payment from a patient and covers it up with the recording of a payment from another patient; this fraud scheme usually builds from patient to patient or until the employee is caught or covers up the scheme with an adjustment or write-off.
  • The Office of Inspector General (OIG) Health Care Fraud Prevention and Enforcement Action Team’s guidance to health care providers in Operating an Effective Compliance Program includes:
    • Having open lines of communication between management and compliance personnel
    • Maintaining an anonymous hotline to report issues to appropriate compliance personnel
  • Another study by the ACFE revealed the following occupational fraud statistics:
    • 5 percent – the amount of annual revenue a typical organization loses to fraud each year
    • 18 months – median amount of time before fraud is detected
    • $140,000 – median loss caused by occupational fraud
  • Research by the ACFE also shows initial detection of fraud is much more likely to be detected by tips (43 percent of all detection) than any other method. When a hotline was in place:
    • Fraud schemes were detected an average of 12 months faster
    • Median loss was 44 percent less

Why IntegraReport?

  • The basic IntegraReport service provides many valuable features, including:
    • Access to IntegraReport phone hotline and Web portal for all employees
    • Hotline monitoring by BKD fraud and compliance professionals
    • Setup and access to video explaining how the hotline service works
    • Full transcription of hotline reports routed to up to three designated individuals
    • Quarterly dashboard reporting of overall hotline use
  • Other optional services available to IntegraReport customers include:
    • Hotline and Web portal access for patients and vendors
    • Hotline implementation training via broadcast or in person by BKD certified fraud examiners
    • Employee fraud awareness training by BKD certified fraud examiners
      • Live broadcast or in person
      • Access to on-demand training video for employees
  • Samples or custom hotline rollout and promotional material

BKD’s IntegraReport will help you establish a credible anti-fraud and compliance program, which can help decrease the cost and duration of occupational fraud or compliance risks in your organization.

To learn more about fraud in health care, as well as BKD’s IntegraReport, BKD FVS Managing Partner Jim Snyder will be presenting a webinar on Thursday, April 10, at 10 a.m. Central time. You also may contact your BKD advisor.

BKD LinkedIn BKD Twitter BKD Youtube BKD Google Plus