Compliance Audits

Home health and hospice agencies are facing heightened audit scrutiny from various entities, including the Centers for Medicare & Medicaid Services (CMS), Office of Inspector General (OIG), Unified Program Integrity Contractors (UPICs), Medicare Administrative Contractors (MACs), and state health departments. These audits focus on ensuring accurate billing and reimbursement, compliance with federal and state regulations, quality of care, and the prevention of fraud and abuse. Auditors meticulously examine resources such as Electronic Health Records (EHRs), claims data, internal compliance programs, audit tools and software, government databases, training programs, professional consultants, legal and regulatory guidance, patient surveys and feedback, and internal audit teams. This increased scrutiny aims to safeguard public funds, maintain high standards of patient care, and uphold the integrity of healthcare services. To navigate these audits successfully, agencies must maintain rigorous internal controls, thorough documentation, and continuous compliance training. Preparing for audits involves conducting regular internal audits, ensuring accurate and thorough documentation, staying updated with regulatory changes, training staff on compliance requirements, and utilizing professional consultants for guidance.

Visit the following resources to learn more about regulatory audits.

• Centers for Medicare & Medicaid Services (CMS) – Audit Overview
• Office of Inspector General (OIG) – OIG Work Plan
• Unified Program Integrity Contractors (UPICs) – UPIC Information
• Medicare Administrative Contractors (MACs) – MAC Jurisdiction Information
• State Health Departments – State Health Agencies
• Training Programs and Compliance Tools – Compliance Resource Center