Case Management Software for Health Care Investigations

As the US government continues to crack down on the health care industry, hospitals and health care professionals are increasingly liable for their actions.

Posted by Joe Gerard in Healthcare on November 17th, 2010

This week we’re off to Vegas to attend that NHCAA’s Annual Training Conference. In the spirit of the event, I figured a post about health care investigations was quite fitting. The health care industry is heavily regulated (and scrutinized), and in the US, is rapidly changing. The fines, consequences and negative media attention surrounding health care fraud and misconduct are higher than ever before. As the US government continues to crack down on the health care industry, hospitals and health care professionals are increasingly liable for their actions. Case management software offers a variety of solutions for health care professionals and investigators.

Here’s a quick overview of a few of the ways case management software helps simplify health care investigations:

Leave No Case Behind

Case management software is so much more than case tracking. When a complaint or issues is entered into the system, automatic alerts are sent out to investigators, informing them that a new case is in the system and has been assigned to them. Cases can be entered through multiple channels- a hotline, a form on your company intranet, an external web form or the old fashioned way of manually entering a case once it has been reported verbally to a supervisor. All of the cases are entered into the system, keeping all of the information in a centralized location. This makes it easier to ensure that each complaint, incident and issue is investigated and resolved.

HIPPA and Privacy

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Make sure patient and employee information stays private. Use case management software that is configured to comply with industry, federal and state laws. Investigations must comply with the law or else you’ll be stuck paying the price. A lot of personal information needs to be handed over during a health care investigation- transferring this information electronically raises security and data privacy issues. Case management software already has the necessary safeguards built into the system to make sure information stays private and doesn’t land in the hands of the wrong person. You can even drill down deeper to restrict access within your own investigative team for additional privacy.


There are a number of different departments and reporting lines within the health care industry. Chances are, each investigator prepares investigation reports their own way. This can be challenging for decision makers and regulatory agencies, as reports look different and might be hard to follow. Case management software not only reduces the time it takes to prepare an investigation report but since each report is being generated from within the same system, each report will be created in a consistent format (regulators and outside agencies love when they receive consistent reports).

Prevention and Improvement

In the health care industry, professionals want to know which areas could be performing better and what the trends are- common allegations, allegations by location, etc. Dynamic dashboard reports help identify trends, allowing you to make improvements and improve quality where needed. Since quality and performance are incredibly important to health care professionals, these reports provide you with insight you may never have had access to when recording investigations in Excel or an in-house solution.

Joe Gerard
Joe Gerard

CEO, i-Sight

Spend my days showing off the i-Sight investigative case management software and finding ways to help clients improve their investigations. Usually working with corporate security, HR & employee relations, compliance and legal teams.

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