tci Medicare Compliance & Reimbursement - 2010 Issue 6
RISK MANAGEMENT: Counteract Outside Consultants From Turning Whistleblowers
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Article Overview
This article examines a healthcare compliance risk-management issue involving outside consultants and whistleblower activity. It explains why providers may want to assess the confidentiality posture and background of third-party auditors or advisors, and it discusses the broader organizational risks that can arise when external reviewers identify billing or reimbursement problems. The piece is aimed at healthcare leaders, compliance professionals, billing managers, and anyone responsible for managing consultant relationships and fraud-and-abuse exposure.
Why This Topic Matters
Providers often rely on outside consultants, but those relationships can create compliance and confidentiality risks if issues uncovered during review are reported externally. Understanding the article helps organizations think more carefully about vetting consultants and managing exposure to whistleblower-related investigations and litigation.
What You Will Learn
- Why outside consultants can create compliance and confidentiality concerns
- How whistleblower activity can affect healthcare organizations
- General considerations for vetting third-party auditors and advisors
- How risk management and compliance planning relate to consultant oversight
Who Should Read This
- Healthcare compliance professionals
- Revenue cycle and billing managers
- Hospital administrators
- Risk management staff
- Healthcare attorneys
- Practice managers
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