VAK Russia 5.2.1
VAK Russia 5.2.3
VAK Russia 5.2.4
VAK Russia 5.2.5
VAK Russia 5.2.7
UDC 35
UDC 351.72
UDC 351.9
The article presents a methodology and tools aimed at identifying cases of misuse of compulsory medical insurance funds by medical organizations. The basis of the approach is the analysis of cash flow (financial flows) on the settlement accounts of the objects of control, carried out through the study of the primary sources of financial information – payment orders. This choice of source data minimizes the possibilities of control objects for manipulation when aggregating information. The author offers tools for identifying key features in completed payments, encoding them, and then using them to build reporting forms and analytical cross-sections. Comparing the results of the analysis performed by the auditor in accordance with the norms of current legislation with the data provided by the object of control allows us to significantly narrow the space for concealing the facts of misuse of funds. The use of programming languages at the average user level makes it possible to automate these processes and further significantly speed up the work of the auditor. Special attention is paid to the use of additional filters when processing payment information, which make it possible to identify signs of interaction between medical organizations and unreliable counterparties, as well as to detect suspicious parameters of financial transactions (frequency, dynamics of amounts, repeatability of transactions, etc.). The article argues for the need to expand the set of analytical tools used by auditors to improve the quality of control and timely detection unfair behavior of participants in the compulsory health insurance system. The article is recommended to practical specialists of the Control and Audit departments of the territorial compulsory medical insurance funds, who directly verify the targeted use of funds by medical organizations. The methods and tools proposed in the article can significantly improve the efficiency of their work. In addition, the article's material will be valuable for specialists from other structures whose responsibilities include monitoring the distribution of financial flows both within a single organization and within a closed-loop financing system. The approaches presented in the article can be adapted for use in various fields where there is a need for strict control of the intended use of funds.
healthcare, compulsory medical insurance, compulsory medical insurance, misuse of budget funds, financial performance verification, medical organizations, mathematical modeling
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