Revisions, Controls , Investigations and What Next?

Overview

The authors discuss problems concerning the further procedures of the health insurance company in relation to contractedhealth facilities where the character of described check up data and the extend of ways of unjustified reporting of the healthcare might arouse suspicion that not always mere administrative errors are involved on the part of the health facility whichcould be explained by the large volume of accounting or the pretentious character of recording of provided health care. Alsobecause at least a certain part pertains to a large number of workplaces with different specialities in the same health institution,they ask the reader whether the described way of recording of provided health care is due to the behaviour of some individualsat selected workplaces or whether a systemic uniformly controlled matter with personal responsibility is involved. The leadingidea is to find an answer to the question how to proceed further in such situations, how to ensure adherence to the law fromthe aspect of expedient spending of financial funds and also how to protect the insurance company as an institution and itsemployees, in particular in those instances when the control mechanism of other institutions incl. the founders failed so far.

Key words:
control activities – revision activity – revisions – unjustified charging for health care – agreements in contracts –cancelling of contract – oppression