Health Plan Management: Do You Have Your Internal Controls Under Control?
Linh Crider, CPA, CFE
Internal controls perform an essential role in the health claims process. In most plans, the internal controls encompass basic procedures such as segregation of duties, system access, quality control reviews, and system edits. However, there are a few procedures that are frequently missed by Health Plans, heightening the risk of errors or fraudulent payments. From an auditing perspective, it is important for plan management to review their control procedures to ensure that the following items are […]