Remote clinic and diagnostic centre audits
Insurers and TPAs rely on clinics and diagnostic centres to treat and test their members. Most are honest. A few inflate bills, bill for tests never done or exist only on paper. Auditing every site in person is slow and costly, which makes remote audits attractive.
Why it matters
Claims from a single doubtful clinic can be large, and repeated. Early checks protect honest members and keep premiums fair.
What a remote audit looks at
- Existence and address: the premises match the registered address, with a clear signboard.
- Registration and licences: display of valid registration and staff qualifications.
- Equipment: scan, lab and other machines that are billed for are present and working.
- Staff: doctors and technicians who are named in records are actually on site.
- Patient load: a reasonable number of patients for the claims being raised.
- Records: registers, reports and billing match.
- Hygiene and safety basics.
How to run it on video
- Schedule the call in clinic hours
- Ask the owner or manager to walk with the camera
- Record location and time
- Ask for random items, such as today's patient register or equipment serial numbers
- Compare what you see with the claims raised
Signs to follow up
- The site cannot be shown live or the camera keeps moving away
- Machines named in bills are not on site
- Staff cannot explain procedures
- The address is a residence or shared space
Report what you saw
A good audit report lists what was seen, what was not shown and what needs follow-up, with the date, time and person who joined. Share findings with the clinic and give it a fair chance to explain before any action is taken.
How Praman helps
Praman by SatyaSakshi lets TPAs and insurers run the audit as a recorded WhatsApp video call. The owner shows ID, completes a face match and liveness check and takes the camera through the clinic, with location and time recorded. Registration and bank-account checks can be added where enabled, and a reviewer approves the report.
Frequently asked questions
Can a clinic be audited without visiting?
Many basic checks can be done on live video with location and time, and a physical visit can be kept for doubtful cases.
What should be visible on the video?
The signboard, registration displays, doctors and staff on duty, equipment, patient areas and records, with the person's consent.
How often should audits be done?
On empanelment, then periodically or when claim patterns look unusual.
Related: how Praman handles this for businesses · all instant checks
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