When patients were complaining on Reddit about a health care organization trying to collect more from them for a service than the amount on their explanation of benefits, consultant Melissa Scott dug into this and found similar comments on the social network from employees of the same organization.
“The perception of what it was like to work for the organization supported that something improper was likely happening,” said Scott, a managing director at Stout, a global advisory firm. “This went on for a long time.” It’s an example of why the things patients and employees say outside of hotlines and employee surveys are an important source of data for auditing, monitoring and risk assessment, in addition to more familiar sources, such as the results of internal audits and external audits from the HHS Office of Inspector General (OIG) and false claims settlements from the U.S. Department of Justice (DOJ).
The comments people make on certain social media and websites can be enlightening. One place to look: the message boards on www.cafepharma.com, where patients and employees alike speak anonymously about their providers and employers, Scott said.[1] Inquiring compliance professionals could search, for example, with words like “kickback” or “fraud.” Although in some respects the venting should be taken with a grain of salt, “it can point you in a direction to some potential issues.” She also scans Glassdoor, Yelp and the Better Business Bureau for possible problems that might not surface otherwise. “It’s pretty amazing what information we can find publicly.”
Leveraging data for audits and investigations and using it to “round out your risk profile” is a way for organizations to identify their own problems as soon as possible and defend themselves if necessary, Scott said at a March 4 HCCA webinar.
“If you’re a provider and don’t know and can’t understand your own data, someone else will do it for you,” added attorney Scott McKenna, with Spencer Fane LLP. “You want to be in a position to control the narrative of your own organization.”
