4 Steps to Increasing Your Healthcare Organization’s Confidence When Managing Fraud and Compliance

Kyla Kent |

For healthcare organizations, building trust with patients is an essential part of providing the best care. It allows organizations to develop deep and meaningful relationships with patients over their lifetime and it plays an important part in developing and maintaining a positive brand reputation. Unfortunately, employee fraud can have a big impact on an organization’s brand reputation and undermine the trust of your patients, which can take years, if not decades to rebuild. And while many organizations have processes in place for auditing employee spend, a recent fraud and compliance survey among healthcare industry professionals found a lack of confidence in current procedures.

What can you do to better manage compliance so that you can regain confidence when fraudulent behavior arises?


1. Prioritize employee policy compliance

With almost 20% of travel and expense (T&E) expenses falling outside of policy, it’s no surprise that monitoring and auditing expense reports should be made a top priority. Whether you use an internal team or external auditors, making sure T&E expenses are within policy is important part of ensuring employee compliance.

Mileage expense, for example, is one of those T&E expenses highly susceptible to fraud and non-compliant spend primarily due to its lack of regulation and large size. In the U.S. alone, healthcare workers drive 1,700 miles each year on average—the highest among all industries—and claim 20% more mileage expenses as compared to other industries. It is also found that travelers, on average, over-estimate their mileage by 15%, only adding more unnecessary costs for your organization. But fraud and other types of non-compliant spend can lead to more than just monetary loses. Essentially, your organization’s reputation is on the line.


2. Procedure: Your first-line of defense

Having an expense process in place goes a long way when it comes to fighting fraud. Determine if your procedure can withstand fraudulent behaviors by checking which actions your organization uses to manage your shield of defense:

  • Require receipts for most, if not all, expenses
  • Require approval of expense reports before reimbursement
  • Have audit rules integrated into spend technology
  • Use reports to help spot problems

If you checked all of the items above, then you’re on the way to a strong first-line of defense. Survey respondents found a combination of technology, policy, and managerial approvals is the most successful approach to fight fraud.


3. Compliance goes beyond expense policy

It’s always important for employees to follow the rules and comply with your organization’s internal expense policies, but not adhering to industry regulations can come with bigger fines and even larger reputational losses. When asking healthcare industry respondents if they felt their company could be potentially at risk for global regulations and compliance, 58% answered “Yes” or “Not sure.”

Are you unsure that your organization’s solution for employee spend management has the ability to help safeguard you from violations? If so, it’s time to start asking some questions as fines are costly for those who aren’t compliant. Stark law penalties, for example, can run up to $100,000 for each arrangement considered to be an avoidance scheme. With regulations constantly changing, you can’t afford to be unsure.


4. It’s time to move away from your manual process

Automation and cloud technology are no longer out of reach, however, 33% of respondents reported that they still spend about 76 hours or more per month auditing expense reports. That’s 76 more hours per month that could go into building patient programs and services.

With automation and artificial intelligence (AI) on your side as part of an integrated employee spend management solution, your organization could:

  • Reduce expense report errors by up to 66%
  • Shorten auditing time by as much as 90%
  • Thoroughly audit 100% of expense reports


For more information on managing compliance and fraud visit our Compliance and Fraud Solutions page.