Case Studies: Hospitals
Outpatient Psychiatric Clinic Internal Audit
BlickenWolf was engaged by a large integrated healthcare delivery network
to perform a compliance evaluation of their outpatient psychiatric
clinic. Upper management had raised concerns regarding the accuracy
and validity of the operations, billing and coding, and documentation
process of this outpatient psychiatric clinic.
Academic Medical Institution Billing and Coding Practices
Investigation and Voluntary Disclosure
BlickenWolf was retained by a state academic medical institution’s
counsel to investigate its client’s billing and coding practices. The
institution, which owns and operates a number of physician clinics,
discovered through the internal compliance office’s billing and coding
audits that a large number of physician assisted services were not
documented according the federal and State documentation requirements.
The audits revealed that documentation did not sufficiently support the services and medical codes that were charged to federal payers. BlickenWolf conducted a probe sample of both Medicare and State Medicaid claims. Subsequently, we conducted an analysis of expended samples of each claim type and calculated the appropriate overpayment amounts using statistical extrapolation, resulting in a disclosure and repayment to the Office of Inspector General (OIG).
Academic Medical Institution Investigation
BlickenWolf was engaged by a major academic medical institution’s legal
counsel to perform a shadow audit of certain patients’ billing and
medical record documentation that were provided to the U.S. Attorney’s
Office in response to a subpoena that was issued to the provider.
We conducted extensive analyses of the client’s billing and medical
record documentation to determine the direction of the government’s
Grand Jury investigation and to provide plausible legal strategies
for the institution’s counsel.
