Review each of the case study #2 (page 229) and analyze the situation. If you we
ID: 128291 • Letter: R
Question
Review each of the case study #2 (page 229) and analyze the situation. If you were the administrator of the organization, how could you use internal audits to uncover the fraud before an external audit occurred? What type of internal audit would you use? Be certain to include a clear description of the scope of your audit.
Case Study #2 Lee R. Rocamora, M.D., North Carolina, agreed to pay $106,600 to resolve his liability for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that the practitioner requested pay- ments from Medicare beneficiaries in violation of his assignment agreement. Specifically, the practitioner allegedly asked his patients to enter into a memberhipetione his to enter into a membership agreement for his patient care program, under which the patients paid an annual fee. In exchange for the fee, the membership agreement specified that the practitioner would provide members with: (1) an annual comprehensive physical examination; (2) same day or next day appointments; (3) support personnel dedicated exclusively to members; (4) 24 hours a day and 7 days a week physician availability, (5) prescription facilitation; (6) coordination of referrals and expedited referrals, if medically necessary; and (7) other service amenities as determined by the practitioner. Source: U.S. Department of Health & Human Services.Explanation / Answer
An internal audit focuses on uncovering internal control weaknesses and evidence of fraud, waste or abuse.
No. Of annual comprehensive physical examination carried out, No. Of patients who received appointments on the same day or next day, No. Of referrals and prescriptions provided.
2. One-on-one interviews with employees and the patients and process observations to collect information regarding availability of dedicated support personnel and 24/7 availability of physician.
3. Financial Transaction matching and recalculating already-reconciled financial statements such as monthly bank reconciliation can also be planned.
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