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Overview of Contracted Primary Healthcare Providers Enrolment Audits

Theresa Mclean made this Official Information request to Ministry of Health

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From: Theresa Mclean

Dear Ministry of Health,

I understand the MoH randomly audits the eligibility and validity of enrolments with contracted primary care providers. It is difficult to find up to date information about this process. Could you please provide answers to the following questions, and if possible, direct me to recent resources around preparing for enrolment audits.

1. How many random enrolment audits have been carried out over the past 5 years?
2. What is the largest ($NZD) financial clawback a DHB has claimed back following an enrolment audit?
3. What is the usual sample size of enrolled patients, which is then extrapolated across the practice? Is there a method for determining this sample size?
4. Are the findings of an enrolment audit at a single practice sometimes extrapolated to all practices within that PHO?
5. Are practices given time to remedy the random audit findings?
6. How much notice are practices given before an random audit of enrolments?
7. If possible, can you provide a summary of the most common reasons for enrolments being assessed as non-compliant?

Yours faithfully,

Theresa McLean

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From: OIA Requests

Kia ora

 

Thank you for your request for official information received 23 February
2021 for:

 

"I understand the MoH randomly audits the eligibility and validity of
enrolments with contracted primary care providers. It is difficult to find
up to date information about this process. Could you please provide
answers to the following questions, and if possible, direct me to recent
resources around preparing for enrolment audits.
1. How many random enrolment audits have been carried out over the past 5
years?
2. What is the largest ($NZD) financial clawback a DHB has claimed back
following an enrolment audit?
3. What is the usual sample size of enrolled patients, which is then
extrapolated across the practice? Is there a method for determining this
sample size?
4. Are the findings of an enrolment audit at a single practice sometimes
extrapolated to all practices within that PHO?
5. Are practices given time to remedy the random audit findings?
6. How much notice are practices given before an random audit of
enrolments?
7. If possible, can you provide a summary of the most common reasons for
enrolments being assessed as non-compliant?"

 The Ministry's reference number for your request is: H202101850.

 

As required under the Official Information Act 1982 we will endeavour to
respond to your request no later than 23 March 2021, being 20 working days
after the day your request was received.  

 

If we are unable to respond to your request within this time frame, we
will notify you of an extension of that time frame.

 

If you have any queries related to this request, please do not hesitate to
get in touch.

 

Ngā mihi

 

OIA Services

Government Services

Office of the Director-General

Ministry of Health

E: [email address]

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Kia ora,

 

Please find attached a letter regarding your request for information.

 

Ngā mihi

 

OIA Services

Government Services

Office of the Director-General

Ministry of Health

E: [email address]

 

 

****************************************************************************
Statement of confidentiality: This e-mail message and any accompanying
attachments may contain information that is IN-CONFIDENCE and subject to
legal privilege.
If you are not the intended recipient, do not read, use, disseminate,
distribute or copy this message or attachments.
If you have received this message in error, please notify the sender
immediately and delete this message.
****************************************************************************

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This e-mail message has been scanned for Viruses and Content and cleared
by the Ministry of Health's Content and Virus Filtering Gateway

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