Compliance Audit

Franco Signor has provided Strategic MSP Compliance Audits for nearly 4,000 RREs and has reviewed the data in over 5,000,000 claims. RREs have been reporting all sorts of data to Medicare for several years. Failure to fully comply can expose your organization to deep Federal scrutiny and monetary penalties. Our SMCP can identify issues in your system before Medicare does.

Mandatory Insurer Reporting Data Compliance Audit

We review your claims data to determine overall compliance with Section 111 MMSEA reporting requirements. Penalties of up to $1,000 per day per claim are part of the law and the U.S. Government has statuary rules for its enforcement. Our audit service identifies gaps within your present system, provides best practices to close them and suggests methods to improve validation of data that avoid future reporting issues. The result is the industry’s best mitigation program that reduces, if not eliminates, potential penalties.

Conditional Payment Compliance Audit

We analyze your claims data to determine if there is any exposure to unresolved Medicare conditional payments. The insurance company or self-insurance plan remains responsible for conditional payment reimbursement to Medicare even if the funds have been paid to the claimant as part of the settlement and irrespective of contrary settlement language or releases. The audit determines whether claim workflows, presently in place, adequately manage conditional payments or need added best practices to close gaps. Failure to address this issue may lead to collection actions by the U.S. Treasury including the recovery of double damages.


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