Improved Transparency with Healthcare Compliance

Organized crime in the healthcare sector? German health insurers defrauded to the tune of billions at the expense of those paying nursing care contributions? Measures that are dangerous or hazardous to health selected to maximize profit?

The complexity of the health care market with its abundance of players is accompanied by increased susceptibility to corruption, putting a blemish on the entire industry. The term “invisible crime” has become synonymous with the market. And, consequently, these offenses will remain invisible unless they are actively tracked down. So how can this be done? How can you shed light on this issue and gain control of the flood of data?

Transparency, integrity and optimization are key to making sense of the increasing interdisciplinary complexity of the digital world.

Benefits Delivered by Healthcare Compliance

Our intelligent internal control system provides you with a modern preventive tool:

  • Prevention (e.g. individual and association liability)
  • Reputation management (through proactive detection and targeted follow-up of tips and whistleblowers)
  • Fraud (risk) management
  • Efficient risk management based on regulatory requirements

Our intelligent internal control system (iICS) provides a modern, preventive answer to challenges in the healthcare industry.

Cutting-edge tools based on the mature iICS technology systematically bring together your data from all relevant systems across the company via interfaces while taking into account the particularities of the healthcare sector (e.g. Diagnosis Related Groups in hospitals, image processing in pharmacies) as well as legal provisions (such as compliance with data protection, anti-corruption, competition and antitrust law and good practice). Data analysis and automated control actions allow you to identify anomalies. Increased transparency into risk delivers time and cost savings.

We address regulatory changes and shifting customer and market behavior with smart digital methods such as process mining, robotic process automation and artificial intelligence. These tools also help us measure the effectiveness of the intelligent internal control system.

We complement our data-driven tools with additional GRC tools such as fraud risk management according to COSO.

Would you like more information? 

 
Your contact

Wolfram Tiletzek

metafinanz Informationssysteme GmbH
Leopoldstrasse 146 | 80804 München, Germany

Tel. +49 89 360531-0

Mail: wolfram.tiletzek@metafinanz.de