Auditing and Monitoring

The Corporate Compliance Department Audit Group is responsible for identifying operational areas of audit risk for Baptist Health and performing audits to measure the risk level present. Based on audit results, the Audit Group makes recommendations to mitigate/eliminate the risk, improve processes for the area of risk, and provide training and education to support compliance with applicable laws and regulations. Subsequent monitoring of an audited area of risk is performed to ensure the recommendations have been incorporated into the daily operational processes. 

Audit risk areas for which improper Medicare and Medicaid payments may be received are determined by the review of various resources:        
  • The Office of Inspector General (OIG) Annual Audit Work Plan
  • CMS’s Comprehensive Error Rate Testing (CERT) Program
  • CMS’s Program for Evaluating Payment Patterns Electronic Report (PEPPER)
  • Communications from Baptist’s Medicare Administrative Contractor (MAC), Cahaba Government Benefit Administrators (GBA)
  • Compliance industry publications
  • Best practices

The type of audits the Audit Group performs/manages are federal (Medicare’s and Medicaid’s Recovery Audit Program, OIG audits, and Department or Justice (DOJ) investigations) and internal (Corporate Compliance Department Audit Plan).  

If you have questions or concerns regarding compliance with regulations issued by CMS or correspondence/contact from CMS-Medicare, Alabama Medicaid Agency, Cahaba GBA, OIG, or DOJ, please contact the Compliance Department Audit Group.