The organizational culture of acute care hospital's auditing and monitoring programs as experienced by health information management professionals: A phenomenological study

The fight against health care fraud has been a major issue for Congress over the last several decades, largely due to the fact that fraud results in billions of dollars being lost on an annual basis. The research demonstrates that monies that are desperately needed to restore Medicare's Trust Fund. The primary target of this fight, based on the literature, which is mostly anecdotal in nature, seems to be focused more on acute care hospitals; however, this in no way implies that other providers/entities are exempt from scrutiny. In 2010, the government recovered billions of dollars from the health care industry as a whole; however, the highest netting cases from these efforts were from judgments and settlements with acute care hospitals. This study explored the overall characteristics and organizational culture of acute care hospital's auditing and monitoring programs as experienced by Health Information Management professionals. Auditing and monitoring, which is one of seven components of the Office of Inspector General's compliance program guidance, has been identified as the most important component of a compliance program. The component is the vehicle that can be used to identify, correct and try to prevent fraud from reoccurring. A qualitative descriptive phenomenological design was used to gather interview data using Patton's interview approach. Interviews were tape recorded, transcribed, and analyzed using Giorgi's data analysis five step approach. The end result were themes that provided useful insight into acute care hospitals auditing and monitoring programs as experienced by Health Information Management professionals, as well as the overall organizational culture of acute care hospitals auditing and monitoring programs.