Case Study: a large pediatric multi-specialty organization achieves risk-based audit efficiency and identifies over $100K in compliance risk with MDaudit

Automation Helps Pediatric Group Shift to Risk-Based Audits and Dramatically Increases Frequency with Over $100K of Compliance Risks Identified

A large pediatric multi-specialty organization faced significant efficiency challenges in its compliance department. Relying on manual processes with spreadsheets, the team could only perform limited, routine annual audits. This time-consuming workflow, which included cumbersome document management for audit packages, prevented the group from focusing on risk-based auditing and providing effective, individualized provider education. To address this, they implemented the MDaudit Enterprise platform to automate and streamline their auditing processes.

By leveraging MDaudit's advanced analytics for automated case selection, the organization successfully shifted to a risk-based audit model. The solution enabled highly targeted audits, individualized education, and drastically reduced document management time. This new efficiency allowed the compliance team to conduct over 4,300 audits, identifying more than $100,000 in compliance risks and recapturing $82,450 in revenue, while also improving the average case accuracy rate to just above 80% for their 600+ providers.