Data sleuths find $54 million SA major hospitals failed to claim over lazy record-keeping
Major city hospitals headed towards a budget blowout risked losing $54 million until data sleuths got on the job — but millions more may be gone forever over lazy record-keeping.
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Data detectives have stumbled on potentially $54 million missing from the troubled Central Adelaide Local Health Network’s accounts.
The cash has been recovered but the sleuths say millions more may have disappeared in the past thanks to slack data record-keeping and reporting.
The problem was in coding of services and procedures, where hospitals are paid for services they provide by the Commonwealth — if the coding describing the service is incorrect, so is the payment.
The $54 million in at-risk revenue was discovered, and recovered, by CALHN’s new Data Integrity Unit (DIU).
The funding risk was a result of inconsistent and inaccurate data reported to the Integrated South Australian Activities Collection, which funds hospital activity.
The inaccurate data also created revenue risks in providing necessary information to organise, evaluate and plan health services in South Australia.
The DIU was formed in April to improve the integrity of reported data and respond to the high volume of coding errors, swiftly recovering millions of dollars.
As of mid-June, more than 2000 coded records remained outstanding with errors that, if left unaddressed, could have placed approximately $23 million in funding for hospital activity at risk.
Staff from the DIU have now corrected virtually all such errors, providing a windfall in revenue CALHN was owed but may not have claimed.
CALHN is now in the hands of administrators KordaMentha as its budget blowout ballooned towards $300 million a year.
In their first six moths KordaMentha has managed to claw back more than $100 million — prior to the data discovery.
KordaMentha investigated the coding issue as part of their original report to government and estimated millions were lost in prior financial years because of the issue.
Their initial report found incorrect coding at the state’s flagship hospital, the Royal Adelaide, incorrectly indicated an activity level more on par with Mt Gambier Hospital — and so were the subsequent federal payments.
Across CALHN its investigation found 14,222 uncoded records, which was partly blamed on the controversial EPAS electronic patient record system.
CALHN chief executive Lesley Dwyer said correct coding of procedures for payment was vital.
“It is important that we do everything we can to make sure we are adequately funded for the services we provide,” Ms Dwyer said.
“The common causes of errors has been identified and the DIU team has begun addressing the errors at the source.
“The team will now begin rolling out targeted education throughout CALHN to reduce the error rates, and will work with Sunrise EMR Project team (overseeing electronic patient records) to improve system functionality. The DIU will continue to actively undertake reporting to ensure that we will not lose any funding next year.
“I’d like to thank the team for all their hard work and for achieving such a great result.”
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All public hospitals are required to report activity information to the Integrated South Australian Activities Collection and there are both State and Federal guidelines about data acceptance.