Risk Intelligence Map

Health Care Providers Sector Risk Intelligence

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Businesses thrive by taking risks but falter when risk is managed
ineffectively. A Risk Intelligent Enterprise™ recognizes this dual nature of
risk and devotes sufficient resources both to risk taking for reward and to
the protection of existing assets. Strategy and
Governance Infrastructure Operations Ethics and Compliance
The Risk Intelligence Map™ provides a unique view on the pervasive, Planning Reporting
evolving, and interconnected nature of risk that executives and managers
may find useful in identifying risks that apply to their organizations.
The Risk Intelligence Map is intended to serve as a guide on the journey
toward Risk Intelligence by helping personnel in all functions of an
Corporate
organization broaden their perspective on risk and improve their ability to Corporate
Strategy Planning External Factors Responsibility and Treasury Finance Risk Services
Fee for Service Health
Managed Care Legal Human Resources
Information
Sales and Marketing Supply Chain Facilities and Assets
Philanthropic Research and
Care and Delivery Patient Services Medical Education Ethics Corporate Compliance Regulatory Compliance Contract Compliance Reporting
Governance Coverage Technology (IT) Foundations Development
execute their risk-related responsibilities. Sustainability

This may be accomplished by using the Risk Intelligence Map to:

spur discussions about risk management topics, including risk Strategy Selection Credit Rating/Cost Organization Organization Facilities and Real Estate Oversight/ Diagnostic and Introduction of Program Quality Structure and Ethical Culture/Tone Compliance
Board Effectiveness Alliances Capital Planning Competition Philanthropy Debt Management Planning/Budgeting Insurance Pricing Payer Contracting Payer Contracting Bankruptcy Competition IT Governance IT Strategy Sales Strategy Planning Grant Management Specialty Care Medical Care Medicare/Medicaid Vendors Strategic Reporting
identification, prioritization, measurement, and mitigation and Execution of Capital Structure Culture Equipment Management Monitoring Treatment Services Services and Accreditation Oversight at the Top Organization

facilitate the connection of risk management silos

Poor Lack of alignment of Inability to identify Lack of capacity or Inadequate Downgrade in credit Lack of a well- Default in repaying Inappropriate Incorrect estimate of Failure to comply Ambiguous terms Inappropriate Failure to define Lack of Lack of leadership Poorly executed Failure to align Misalignment Ineffective sales Failure to plan for Discrepancy High cost of real Failure to Withdrawal of grants Inadequate Inadequate facilities Incorrect or Inadequate Inappropriate Failure to foster an Adverse legal/ Failure to satisfy Inability to monitor Insufficient sharing
identify redundant efforts in place to manage risk communications strategy to alliance inelasticity in competitive analysis rating documented debt obligation business exposure with pricing and conditions in provisions of the and identify duties understanding of the alignment and change technology between IT and force required capacity between physical estate acquisition, demonstrate diagnostics tools to provide specialty inadequate knowledge of oversight policies ethical culture Failure to designate
regulatory changes Medicare/Medicaid compliance with of information
specific executive(s)
from management organizational opportunities capacity to provide philanthropic plan assumptions regulations the contract contract at the governance industry and market effectiveness management decisions to organizational and financial lease or adequate oversight/ Misappropriation of and procedures care services information accreditation (multi-jurisdictional) certification and contractual terms
improve efficiency in compliance and risk management efforts objectives services to patients level process operational plans strategy information construction standards
in charge
and conditions
Antitrust actions Inability to access High interest cost Failure to qualify for the organization Poorly designed Higher inventory monitoring of funds received for communicated to Inadequate Inappropriate licensure Inability to report on
develop risk event scenarios that require integrated responses Inadequate Inadequate analysis capital Insufficient funds for Unreliable insurance eligibility Inappropriate pricing Inadequate due Ambiguity in operates in Unclear lines of alternative sales cost due to foundation grants Use of multiple Inability to provide patients oversight structure performance Noncompliance with requirements key metrics
knowledge of board Failure to select of business partner Inability to meet Disintermediation philanthropic Failure to comply information used in of services diligence on contract terms Failure to recognize authority Insensitivity to Inadequate support Inadequate attention strategies inadequate Inappropriate Suboptimal operations overlapping cost effective Failure to meet incentives Failure to designate country/jurisdiction- Failure of vendors to
responsibilities strategy that relationships increased demand Failure to optimize activities with bond covenants planning and High insurance prospective the course of Failure to comply employee morale structure for IT to strategy consideration or insurance coverage utilization Inability to monitor diagnostic tests treatment Poorly designed criteria for quality of Inappropriate executive to report specific laws and Insufficient internal meet 'business Ineffective
The Risk Intelligence Map should be used as part of an overall risk promotes for health care cost of capital budgeting process premium and/or
Lack of flexibility in contracting parties/ Complex bankruptcy with applicable Misuse of authority governance execution Imprecise metrics to visibility of all factors Misuse/ usage of received introduction strategy education delegation of duties directly to the regulations expertise and associate' presentation of
Failure to monitor
management program that is based on the fundamental principles of the the pricing business partners affecting cost
Inadequate continuous Failure to identify services Incorrect reporting Ineffective debt brokerage costs reimbursement antitrust/pricing Misaligned monitor sales Failure to utilize Safety of patients misappropriation of funds Incorrect diagnosis Negative publicity and monitoring of and control governing body on resources for requirements of information
mechanism
Risk Intelligent Enterprise. These principles define and integrate risk- understanding of the performance and the scope of an Inappropriate of an organization's restructuring Failure to monitor terms Failure to secure regulations Inappropriate corporate culture Lack of risk Lack of correlation strategy success equipment that use and employees accumulated funds or treatment of an Failure to attract Loss of activities unauthorized compliance program Inability to anticipate reporting and HITECH Act
organization's results alliance Inability to optimize reliance on credit philanthropic plans and budgets Insufficient Reputation risk Inappropriate debtor rights delegation of and corporate intelligent decision between IT Inaccurate demand/ renewable or Noncompliance with ailment patients accreditation status activities activities and manage impact optimization Lack of timeliness in
related responsibilities at every level of the organization, and address business capacity utilization ratings for business initiatives coverage against arising from failure authority level to Inaccurate contract authority strategy making spending and Inaccurate supply forecast alternative energy Improper real estate Suboptimal grant terms and of changes in reporting
Unfavorable debt Failure to
issues around governance, infrastructure, management, and ownership. Inadequate attention Poor monitoring and decisions position due to the Improper tax risks to defend prices enter into contracts pricing understand and operational forecasting of key sources accounting utilization of funds conditions Failure to protect Lack of authority legislation and Noncompliance
Limited exposure to to strategy relationship Failure to provide Inadequate economic planning pursue benefits of Inappropriate Inadequate Lack of dedicated requirements trends in the market Excessive whistleblowers and independence regulations resulting in
Payers
management execution management quality patient care Inappropriate monitoring of environment Delay in renewal of antitrust laws and distribution of communication from resources purchases leading Failure to Delay in or non- Delivery of Patient Affiliation government
By implementing these principles, a company can transform itself into a outside of the CEO management of progress and insurance policies regulations decision making top management Risk of to expiration of achievement of the
Outpatient Care Long Term Care
Services Management inspections/
decommission Inadequate Regulatory
Risk Intelligent organization where: and CFO Failure to consider Poor dispute Loss of revenue credit ratings outcomes against Scheduling and Admitting and authority Lack of IT expertise overinvestment in IT supplies and facilities and foundation’s Research and dedication of investigations Reporting
defined objectives Capitation Revenue wastage
data and financial resolution process Cost Accounting Inaccurate actuarial Preregistration Registration Ineffective at the Board level remediate sites objectives Clinical Studies Policies and appropriate Inability to comply
leaders adopt a broad outlook on risk and integrate risk considerations models during with business and Budgeting valuations
Marketing Strategy using the best Procedures
Training resources
Lack of board Pension Excessive divisional performance based Inability to prioritize Inadequate Lack of adequate Clinical Conflict of interest Loss of revenue due with contractual
into strategic decision-making cohesiveness strategic planning partners Management Contract Corporate focus culture mission critical IT environmental outpatient care staff to cater to ineffectiveness between the to Medicare/ terms and Ineffective
Economic functions solutions procedures patient needs Medicaid audits conditions
Operational Inappropriate Delay in updating Failure to collect Inadequate Management Investigations Inappropriate objectives of the management of
the board executes fiduciary responsibilities to ensure that appropriate Planning
Consumerism Conditions/Industry
Failure to maintain insurance coverage patient scheduling signed consent diagnosis/treatment Complex Goal Congruence/ clinical trial Inadequate medical school and Inadequate ethics Inadequate ethics reporting costs
Inadequate data Trends Marketing programs
risk management controls and procedures are in place Community Benefits Sourcing the sponsoring
and financial models Lack of an effective accurate costing and preregistration forms of a patient to organizational Lack of succession not aligned with the Dependence agreements Lack of required Lack of trained procedures and compliance and compliance Insufficient Incorrect
institution Compliance Culture
Board Structure and to support strategic investment records Failure to monitor reduce costs and Failure to comply Corporate design planning organizational specialists nurses policies training program documentation to interpretation of Inefficient systems
capable processes, systems, and trained people exist to act on both Leadership direction Inadequate Inaccurate Changes in industry management team timely reporting Denial of insurance Failure to collect maximize profit with terms and criminality and objectives Capital Project Failure to protect Failure to improve support claims payer contract terms to capture all the
Intangible Assets
risks and opportunities in a timely and coordinated manner departmental projection of a structure Lack of support for a Inappropriate claims co-payment from conditions of questionable Ineffective supplier Management Foundation goals confidentiality of Incorrect diagnosis Failure to deliver patient access Noncompliance with Inadequate ethics Failure to train and conditions reportable items
Failure to test the representation in consumer’s need community benefits Inability to fund business patients Selection of less agreements practices Corporate selection not aligned with results and data or treatment individualized care affiliation terms and and compliance specific business Failure to create a Failure to identify
a consistent approach is used across the organization to manage all Lack of appropriate strategic plan on a plan development Macroeconomic plan pensions within the assumptions Failure to arrange effective treatment
Human Resource
messages not procedures organizational Failure to comply conditions procedures units on the ethics sound culture where and report Nonpayment/partial Delay in filing
Policies and Payroll Information Systems Architecture
classes of risk in an effective and efficient manner tone set by periodic basis Inability to provide changes due dates required services Incorrect recording options Inappropriate level Failure to implement
Procedures
aligned with Copyright/trademark Time or cost objectives High waiting time Inability to handle with State and and compliance compliance-related compliance issues payment by payers reports to the
Hedging Inappropriate
leadership affordable/high Failure to maintain Unreliable of patient of authority to enter anti-fraud controls corporate strategy Inability of the infringement overruns emergencies Federal regulations Failure to prepare policies and matters and issues concerned
Unachievable plans classification of procedures
quality care Business cyclicality services along rural Inappropriate information used in Noncompliance with information Inability to recover into contracts organization to Over dependency Inability to access job-specific are treated with Failure to refund authorities
For more information on the nine principles of Risk Intelligence, see Weak structure/ and underserved actuarial estimates the planning and regulatory costs Inadequate Inadequate Inaccurate payroll System Architecture is not Incorrect establish Lack of labor Lower or non- on foundation goals
clinical trial patients
emergency Inadequate security Faculty Recruiting procedures rigor and objectivity overpayments
Business for Standard of Care
“Putting Risk in the Comfort Zone: Nine Principles for Building the Risk composition of the Inappropriate Demographic routes budgeting process Lack of requirements Inadequate Inconsistency execution of employment processing configuration errors aligned with assessment of appropriate sourcing contracts realization of in achieving related services
equipment arrangements and Retention Failure to track Noncompliance with
Concentration and Customers/Patients strategy Medical Staff
Intelligent Enterprise,” at www.deloitte.com/RiskIntelligence. board deployment of changes Failure to meet management insurance between independent internal standards corporate strategy market size projected benefits organizational Delivery of Support completion of Failure to provide reporting
Model
resources Lack of accessibility pension fund Failure to oversight/ verification agreements and investigations Inefficient payroll Ineffective/delayed Theft of trade objectives Services training personnel with the Health Insurance requirements
Ineffective Inflation/deflation for elderly and obligations appropriately awareness of business goals Violation of processing development, Failure to implement Over-dependency secrets Loss of revenue due Inadequate study Inability to attract/ tools and resources Portability and
Claims Processing Antitrust
The Risk Intelligence Map is not a definitive or comprehensive communication Supplier Inability to attract disabled persons allocate costs hedging activities Noncompliance with Lack of regulatory employment testing, and/or a technology on select vendors to project delays design and research Home Health and retain faculty needed to attain Accountability Act Failure to comply Failure to ensure
Acute Care ongoing compliance
representation of risks that may be encountered by an organization. between and overdependence and retain Monetary and fiscal regulatory Terms and awareness practices Inadequate deployment of new aligned with Underutilization of strategies Hospice Inadequate attention (HIPAA) with accreditation data accuracy and
technology Marketing Programs
amongst board and customers/patients policies Lack of uninsured Failure to monitor Inappropriate requirements conditions not in segregation of organizational Inability to procure intangibles Lack of alignment of to patients leading Inadequate criteria Monitoring and requirements quality in reporting
Consider customizing the Risk Intelligence Map based on risks that impact management Customer
Scenario Planning
and free/charity care
Capital
costs and budgets hedging coverage Delay in claims compliance with Lack of coordination Lack of monitoring duties strategy medical supplies capital process with
Capabilities
Lack of adequate to dissatisfaction for faculty selection
Communication
Auditing Misalignment Failure to comply Failure to comply
Management and
your organization. Areas could include regulatory, geographic, industry, overdependence Inadequate Forecasting
Misappropriation of processing laws and regulations between legal and of compliance with Inability to plan for cost effectively and strategic priorities communication Inadequate Inability to provide between compliance with confidentiality with antitrust laws Inability to monitor
and company-specific issues. Board conflicts of monitoring of Failure to monitor Improper tax Lack of consistent cash other appropriate fair employment Payroll outsourcing obsolescence Inability to develop Inadequate timely across entities and resources to provide high quality and Failure to comply Lack of inclusive culture and provisions of the compliance with
interest or lack of Dependency on customer/patient’s Failure to consider Political Activities/ and evaluate planning evaluation of Underpayment of Failure to monitor departments practices risk business driven information to Lack of Inadequate silos acute care facilities appropriate patient with regulatory recruitment activities Failure to establish Failure to conduct corporate strategy Patient Safety Rule Lack of knowledge accreditation Operational
External Fraud
For more information on customizing the Risk Intelligence Map to meet the independence facilities not owned preferences and scenario planning in Lobbying community benefit Financial distress hedging coverage Improper recording claims business partner's Failure to comply architecture support marketing Misappropriation of transparency in the fundraising care requirements ongoing ethics and routine compliance of antitrust requirements Reporting
by the organization needs the long term plan performance and/or failure of cash compliance with Lack of Tax compliance risk with regulatory programs assets review and approval capabilities Lack of processes Inability to employ compliance audits Failure to outline Inability to protect regulations
needs of your organization, please contact your Deloitte practitioner. Inappropriate planning process Inappropriate Inaccuracy in filing agreements communications requirements Inadequate of budgets to support accurate licensed nursing Discrimination in Failure to deliver communications and implement privacy of personally
decision making and Inadequate Customer fraud Inappropriate Improper capital benchmark for Inappropriate of claims leading to and training around consideration for Failure to monitor Inadequate and timely research staff trained in acute patient admission services in Resident Recruiting Inappropriate effective compliance identifiable Failure to consider Failure to disclose
Taxation Risks associated
delegation of monitoring of Failure to consider lobbying budgeting evaluation of medical care rejections Inadequate due employment changes in the marketing programs infrastructure to billing care and discharge accordance with (Matching) Failure to provide a allocation of programs and information financial and clinical Other Business noncompliance with
authorities customer usage key variables in Vendor or business Community Need hedging diligence on standards with having different business with business support fund raising goals means for resources for disciplinary policies integration impacts Partners applicable
performance systems (Clinical Contracting
scenario analysis partner fraud Negative publicity Assessment Failure to evaluate Inability to protect prospective partners Construction Lack of clinical Lack of a employees to raise monitoring and Risk of penalties regulations
Systems, Financial Business Health and Safety auditing
Inadequate attention Inappropriate from competing optimal sources, Noncompliance with sensitive patient contracting parties/ Management Lack of leadership research systems multidisciplinary Inadequate ethics and from noncompliance
information business partners Systems, Ancillary requirements not and processes compliance issues
to strategy and segmentation Inadequate Ineffective anti-fraud interests and cost of finance and transfer pricing Failure to monitor Utilization Lack of cohesion/ support and approach to acute communication of Failure to monitor Ineffective data
Performance/Talent Systems, being met by
execution responses to programs (external political Inappropriate optimal capital terms timely reporting Management Health and Welfare cooperation Ambiguity in accountability care treatment Comprehensive program Failure to Policies and business partners usage and reporting
Management and Ambulatory systems
Insufficient patient scenarios fraud) commentators methodology to structure Litigation from Benefits between marketing contracting terms Time or cost Lack of adequate Care Management prerequisites and Failure to provide an continuously Procedures
Compensation Systems, Enterprise Exclusion from
Poor cooperation volumes assess community Inadequate or overly Inadequate policies, inaccurate/ Resource Planning Ineffective software and sales and conditions overruns processes for Poor nurse to institutional policies anonymous monitor ethics and Tax Exempt/ Failure of business Delays in reporting
Environmental, organizations for residency Government
and organizational Failure to find needs Lack of aggressive tax procedures and incomplete Inefficient Government Systems) acquisition periodic review, Collaboration/ patient ratio reporting line compliance Taxable Status partner to meet
Health and Safety positions Programs
alignment appropriate partners transparency in the planning controls registration and scheduling of health Investigations Inadequate Unreasonable methodology Inappropriate Misappropriation of communication and Alliances Inability to deliver Failure to develop requirements Lack of data quality
(EH&S) Sourcing of Funds
Failure to establish review and approval admittance care resources employee benefits performance Failure to identify selection of contract assets enforcement of comprehensive care Failure to engage appropriate policies and integrity
Capacity Planning health and safety
Political instability priorities based on of budgets Inability to meet tax and health care expectations target audience partners Inability to attract employees and and procedures Failure to align Misdemeanor Misalignment
Growth Clinical Innovation policies
Compensation/ identified needs requirements Improper planning Failure to design Lack of guidance plans Failure to keep pace Failure to identify Skilled Nursing Patient/customers high quality keep ethics and organization relating to fraud, between the ethics
Lack of alignment of Prison Health
Performance Corruption risk of proactive environmental regarding matters of Incentives not linked Failure to properly Failure to maintain with design and Ineffective fund appropriate alliance Facilities dissatisfaction residents compliance top of Excessive and structure for theft, embezzlement and compliance
the capital process Environment mind
Incentives/ Inability to optimize Inadequate tax risk Financial Charge Capture and procedures safety procedures government Noncompliance with to performance System Acquisition track results relationships with technology changes Inadequate attention raising strategy partners inconsistent policies optimizing tax or other financial framework of Reporting Quality
Alignment to strategic investigations Asset Management exemption misconduct business partners
Ineffective strategy Failure to generate capacity utilization Change of the management Counseling Entry accounting and Implementation the service to employees and Mismatch between and procedures and Accuracy
Energy priorities, safety and
development and new services/ government’s role in Incorrect evaluation Lack of policies and standards and Ineffective Unethical marketing providers Noncompliance with patient safety Inability to minimize Inadequate terms Inadequate staff to Failure to identify preferences of
Management and quality
Inadequate communication treatment Failure to provide health care Unexpected cash Inadequate leading to erroneous procedures to Failure to identify regulations oversight/ programs environmental and fundraising costs and conditions for meet patient needs and act upon health Discontinuance of applicants and Failure to establish Failure to qualify for Failure to receive Failure to establish
Alternative Sourcing
disclosure of procedures quality patient care Lack of consistency taxes measures to control Incorrect Delay in updating plans and decisions comply with EH&S areas of concern governance of Delay in Inability to obtain labor laws Lack of coordination alliance problems in prisons Services directors accountability and tax exemptions payment from any business partner Failure to provide
standards Allegations Investigation
compensation Lack of growth in Failure to comply in the measurement pollution assessment of the charge master that could trigger a Ineffective/inefficient executive implementation of IT customer of care Non-availability of Inability to develop a measurement federal health care escrow agreements accurate and
process and new or emerging with lobbying limits Inadequate energy of success of capital Failure to optimize patient’s eligibility governmental employee benefits compensation systems projections Purchasing of Design and funds Lack of comprehensive, Inadequate control Manipulation of rank Inadequate program for any complete
philosophies Failure to adopt new investigation process information
markets conservation projects against tax savings from Regulatory Incorrect charge Lack of awareness plan administration Services technical risks in Lack of active transparency in interdisciplinary care over communicable Inappropriate order lists Failure to establish consideration of items or services Pass-through
services/treatment metrics Market Research provided, ordered,
Market Analysis and business sanctions Noncompliance with capture and entry of environment, Mismanagement of Use of unsupported complex quality improvement alliance and plan for each patient diseases consideration of the Lack of defined Lack of defined non-intimidation and form 990 liability from
procedures or prescribed
Misalignment of Failure to identify Expansion Inability to utilize relationships regulations health and safety Improper internal Noncompliance with Potential for software and software and construction initiatives collaboration utilization rate of protocols to address protocols to conduct non-retaliation presentation and business partners Failure to provide
performance metrics growth opportunities Hazards/ alternate sources of Inability to analyze Safety of patients Missed charge regulations investigation and plans as fraudulent behavior hardware inventory hardware Inability to estimate projects processes Inappropriate use of Inappropriate use of services allegations investigations policies for good- reporting timely information
Markets Competition requirements Government
with long-term Failure to monitor Catastrophic Loss energy key financial ratios and employees Loss of patients/ capture and entry inefficient documented by Analysis of the business needs Ineffective cleaning medications medications faith participation in
Funding the compliance sanctions resulting
strategy advances in new Incorrect market and perform stress- business communication local, state, and Ineffective equity Inability to generate Mismanagement of insignificant data Lack of or practices and Noncompliance with Patient/customer Failure to document Failure to identify Outdated
program from noncompliance
service/treatment data used for Noncompliance with testing programs in times of country regulations and deferred information software and Quality of services inadequate technologies alliance/ Increased patient Violence in prison dissatisfaction inquiries and and assess ethics Captive insurance information and
Credit crisis Medical Research
Inconsistency procedures by analysis Health epidemics Financial market applicable laws and Failure to collect compensation hardware inventory Failure to adopt not as per the resources/ Higher cost of collaboration terms days of stay health care wings allegations, and compliance sanctions reporting tools
between executive competitors (SARS, influenza, risks regulations on service fees Inability to control process Failure to manage appropriate expected standards infrastructure fundraising Inability to meet including outcomes related risks
Professional Liability and/or actions taken
compensation and Failure to maintain a etc.) energy utilization/ costs acquisition costs Inability to monitor techniques and funding eligibility Private benefit
stakeholder competitive edge in Commodity price conservation Lack of an effective Undesirable performance and methods for market Inadequate Disruption caused Reduction in Clinical Information criteria Failure to identify inurement Lack of prior
expectations Cash Management research Risk Assessment
the market Natural disasters risk credit management Intellectual Property Labor and behavior resulting availability of oversight over the by the weather and/ availability of funds Decision Support Lack of a defined processes and approval from
Mergers/ Maintenance of the Data Management Pharmacy Nutrition Services
process Failure to obtain (IP) Employment Issues from a sense of resources purchasing process or accidents Reduced number of procedure during activities impacted Inadequate regulatory agencies
Markets Acquisitions/ Coding Charge Description
Undue emphasis on Shortfall in returns Man-made hazards/ Interest rate risk appropriate legal entitlement Incorrect resident trainees crisis by ethics and consideration of and ethics
Divestitures Master (CDM)
short-term results from expansion terrorism Inappropriate Failure to maintain advice and conclusions drawn Inefficient supply Inappropriate compliance related Inability to identify joint ventures with committees
Project Financing risks
plans Foreign exchange allocation of cash credit information of professional liability Failure to register IP Failure to Inconsistency in from analysis and and drug utilization Inappropriate Improper Inability to use clinical decision Insufficient funding Loss of sensitive significant for-profit partners
insurance Facility and Tax Exemptions
Misalignment of Financial markets Inability to identify a rate risks customers Inaccurate coding Noncompliance with rights incorporate determination of Change research results records medication/dosage innovative making information through compliance risks on Liability from
Disaster Recovery Physical Security Equipment a routine basis
incentives and risk clear end state Ineffective control State and Federal employment laws incentives and pay Management management recommendation diagnostic and Inappropriate use of inappropriate Failure to regularly Failure to comply damage claims
Financing of Utilization
rewards vision for the over budgeted and Poor credit rating Material financial Noncompliance with CDM regulations Failure to protect into human increases Failure to analyze evaluation Delay in decision funds handling assess the with private use
integration/ projects with actual expenses techniques loss resources policies techniques making organization’s restrictions for tax
Inadequate Change government coding sensitive information current market Purchasing of Failure to obtain Inadequate data Sale of restricted Failure to establish Protests arising
divestiture Third party/Joint harmful
consideration of Management Government Grants guidelines Inaccurate capture pertaining to IP Inconsistency in Inadequate attention Ineffective change conditions Supplies Failure to implement Suboptimal appropriate tax sharing practices drugs without a preparedness controls to mitigate exempt financing from the use of
Venture environmental
Corporate external factors and Funding Inadequate liquidity Inadequate Bankruptcy of data Failure to monitor performance towards critical control processes security controls utilization benefits prescription Failure to develop Confidential patient identified risks animals in research
Requirements impacts Medicare
Responsibility and Insufficient allowance for credit Failure to use coded Infringement of IP compliance with evaluations infrastructure Loss of data/ an appropriate data breach/loss Incorrect private use
Documentation and
Sustainability accounting, tax, Inadequate Failure to screen losses data for performing Delay in updating rights owned by employment laws disruptions Unauthorized Noncompetitive Inadequate Non-availability of Inability to monitor information Noncompliance with nutrition plan for the Inability to bond calculations Inadequate attention
Reporting
(CR&S) regulatory and communication to Project funding Failure to qualify for general financing procedures the CDM others changes into the procurement processes and skilled technicians compliance with anti-kickback patients Corrective Action communicate risks to the safety of
Reporting
operational target stakeholders government grants projects Investment Worker's Lack of awareness Inability to recover production Branding and methods policies to secure eligibility criteria statutes and Discipline across lines of Inadequate participating
Failure to meet screening Inability to audit third and funding Management Compensation Lack of Denial of insurance Failure to protect of employment laws Talent Pipeline/ Physician Network from a business environment Reputation physical assets Opportunity loss of Lack of qualified Failure to establish business consideration of subjects
social responsibility Failure to manage parties Financing of Financial accountability over claims the use of IP among personnel Recruitment Management interruption Absence of a capital investment Inappropriate Conflict Failure to monitor and certified the necessity for transaction taxes
obligations Incomplete due stakeholders Inability to sustain projects in countries Accounting physician coding Insufficient testing comprehensive Ineffective physical utilization of funds Management high nutrition risk nutrition staff treatment Failure to discipline Failure to identify Inability to evaluate Inadequate patient
expectations and documentation procurement policy patients Liability for
diligence Contract risk eligibility criteria with human rights Failure to align Inadequate reserves Customer Failure to support Loss of critical data prior to Inappropriate security risk employees for and report key potential or actual care facilities
unrelated business
Lack of involvement violations investments with the dissatisfaction international patent Lack of succession Inability to stay leading to implementation corporate branding mitigation plans Inability to maintain Failure to monitor Inadequate noncompliance ethics-related trends noncompliance
income activities
from appropriate Failure to achieve Poor labor and long term strategies Inappropriate Lack of insurance Lack of policies rights planning/loss of key updated with compliance actions strategy Inability to maintain tax exemption Inability to anticipate high nutrition risk documentation resulting from self-
levels of synergies from post human rights of the organization accounting policies coverage guiding personnel changes in the Inability to recover mandatory buffer Theft status conflict issues patients Inconsistent Inadequate evaluations and Failure to comply
management merger integration Performance consideration documentation health care processing Unprotected brand stock for critical Inadequate treatment of resources to report audits with lobbying limits
Management Environmental Ineffective Incorrect/inadequate Poor employee profession image supplies leading to Failure to provide guidelines for employees for ethics violations
shortage Failure to achieve noncompliance
Inadequate Recovery monitoring and/or reporting Litigation and retention policies Nonperformance of adequate nutrition teaching physicians
Legal Services consensus to
oversight over mitigation of Dispute Resolution Reduced a post-validation Ineffective treatment Equipment Parking and education to and residents to Inadequate
Health Care Fundraising resolve a conflict
CR&S activities Entity Inability to measure Donations/ investment portfolio Lack of integrity of Billing and Claims Failure to attract competition in the check of negative events Lack of vigilance/ Maintenance Transportation patients document the Failure to reporting of material Communication and Governmental Grant
Outsourcing Reforms/ risk Discharges services provided State Regulations
Rationalization performance Contributions Failure to conduct financial information Processing and retain market due to and crisis oversight of the communicate ethics violations to Training Compliance
Government Actions
Lack of adequate environmental Increased cost of Ineffective litigation employees horizontal management purchasing Untimely resolution consequences of appropriate external
disclosure of CR&S Lack of key compliance audits Inaccurate valuation Inaccurate recording legal services risk assessment consolidation procedures leading Inadequate periodic Inadequate parking Inadequate policies of a conflict Noncompliance with unethical behavior stakeholders
activities Inability to attain Loss of core performance Inadequate Inability to attract of investment of transactions Incorrect discharge Delay in raising bills Poor workforce among physicians Contracting and Failure to follow to procurement of or preventive space and procedures for regulatory and noncompliance Inadequate ongoing Increase in State Lack of information
Information Security counterfeit supplies Wellness Programs Nursing Operations
optimal structure competencies indicators monitoring of donations/ Ineffective portfolio assets summary and processing Untimely resolution Residual claims diversity Outsourcing brand guidelines maintenance fund raising requirements compliance regulations related about government
after rationalization planned health care contributions environmental Management claims of legal issues from disposed or Inappropriate program Lack of Failure to implement communications to fraud and abuse grant requirements
Sole source Inadequate reforms/government management Lack of a formal override of controls Failure to obtain acquired entities Ineffective recruiting physician Erosion of brand transportation Inappropriate changes to correct
Reputation/ actions systems arrangements facilities
Inadequate attention dependence on communication of Inaccurate succession plan for patient sign-off Inaccurate Monetary losses in process Improper bidding Ineffective/inefficient High equipment source of funds Inadequate Inadequate policies systemic program Failure to have an Risk of criminal Failure to manage
Stakeholder
to business outsourced core performance forecasting of key individuals Material processing of the defending lawsuits Inability to defend and selection, access controls Consignment of down time/lower preventive care and procedures issues organization-wide penalties for funds as per
Relations Faculty Billing
forecasts/expansion functions expectations Inability to modify donations/ Failure to assess misstatement of Damage claims bills and claims lawsuits Poor workforce Inability to attract contracting, and Medical Devices utilization Ineffective utilization Inability to meet services related to nursing compliance training noncompliance regulatory
plans operations to contribution risks from regulated Lack of a accounting Inadequate strategic planning and retain ongoing due Vulnerability to Internal of transportation fund raising targets operations program requirements
Failure to Failure of Lack of acceptance address new/revised requirements and unregulated documented estimates Mismatch between planning Lack of preemptive physicians diligence malicious attacks Communication Reduced life of facilities Failure to monitor Failure to establish
reforms and actions materials and investment policy Program
understand trends Inability to gain cost outsourcing agency of key/standard the amount of bills legal risk Lack of qualified Non-availability of equipment Inability to achieve the quality/ Failure to maintain Inadequate Failure to identify an effective Inability to maintain
practices Prevention Assessment and
related to the efficiencies to meet metrics Inefficient financial raised and claims Ineffective management and competent Noncompliance with Poor security and Ineffective anti-virus medical devices Customer desired outcomes performance of continuous care guidelines and train specific compliance program financial and
Evaluation
organization's requirements Inappropriate use of close process processed organizational process talent governmental privacy controls for strategy Lack of alignment dissatisfaction that have been wellness programs businesses affected under the State law programmatic
workforce, creditors, Failure to optimize material nonpublic design regulations outsourced data between internal Higher cost of communicated to Inability to meet Inability to monitor by new laws, performance
customers, and tax benefits Failure to monitor information Poor audit quality Inability to Pass-through Untimely application communications medical devices Inability to handle donors of patient requirements faculty billing Lack of documented Failure to collect the regulations and reporting
other stakeholders Medicaid Funding Medicare Funding designated funds policies
business partners Business Continuity substantiate Ineffective outside liability from Contractual inability of security patches and corporate emergency policies including relevant data and
Waste Management messages/strategy
Management Ineffective service Inadequate charges counsel business partners to review security Dependency on few requirements Noncompliance with Code of Conduct/ information to Inability to obtain
Real or perceived Absence of specific provider oversight evaluation of bad management Implication of and privacy Lack of physical/ medical device Lack of regulatory Ethics evaluate the Failure to track and approval for
Nurse Staffing program
influence of majority supplier criteria in Legislated Legislated debt risk Failure to identify Significant Events practices logical security Ambiguity in organizations transparency to Clinical Standards requirements evidence completion changes in the
Quality of Care
shareholders the area of social Inability to recover reductions in reductions in Noncompliance with Lack of disclosure/ and report false Failure to comply communications donors due to and Practices Inadequate of required training scope, budget or
performance data funding funding applicable waste resolution of claims with legal Lack of segregation Cafeteria and Dining distribution of funds guidance or lack of Failure to identify objectives
Failure to management laws conflicts of interest requirements for Inappropriate Labor walkouts/ of duties Inability to meet Services to different entities clarity in ethical areas of concern Failure to
adequately consider Non-availability of State budget deficits Delayed payments/ and regulations Business technology scheduling of unionization/strikes marketing objectives Failure to identify Inadequate quality Direct Medical behaviors expected and prioritize them understand
Delivery/Returns of employees
and/or respond to critical resources causing payment non-payments due Intelligence Government nurses applicable clinical of care Education (DME) compliance
shareholder when needed delays to health care High waste Payers, including Inefficient records Ineffective change Inappropriate diet standards and Failure to take expectations Clinical
proposals Pricing Medical Technology Payment Posting Physical and Billing and Coding
reforms generation Medicare, Medicaid management Unavailability of management recommendations practices Inability to attract Lack of reporting efforts to Documentation
Operations Environmental Record Keeping
Inappropriate Increase in Failure to capture and Others services skilled nurses External Inadequate return and retain Loss of eligibility system for unethical continuously Failure to provide
Security
Poor corporate attention to critical medicaid population Increased medicare Inappropriate waste appropriate Insufficient due Communication policies Failure to maintain Inadequate customers/patients status behaviors improve the recurring training on
brand perception infrastructure due to the economic information needed program a periodic basis Incomplete,
Failure to comply Inadequate funding gap due to treatment/reuse/ Loss of revenue Delayed payment/ Inadequate client Poor patient diligence in Human hygienic and clean communication and Risk of payment
disruptions environment for decision making inaccurate or
with pricing technical/ retirement of baby disposal practices non-payment by a service delivery outcome Resources Failure to ensure Inadequate physical Inability to identify environment Inaccurate record monitoring Regulatory Reduction in DME Inability to protect denials
untimely
regulations commercial boomers Misappropriation of third party payer the scheduling and security around data Inappropriate mode/ the appropriate keeping noncompliance payments whistleblowers Ineffective documentation
feasibility studies Inability to recover Failure to maintain cash Organizational timely completion of centers audience selection logistics provider Inability to meet Regulatory communication lines Revenue loss due to
Difficult scheduling processes
Inappropriate pricing from a business data quality and Inaccurate uncertainty causes patient requirements Non-availability of noncompliance Lack of adequate to the compliance erroneous billing Inadequate
Risk Oversight Records and situations
of products/services Ineffective/delayed interruption integrity Incorrect Account projections of recruitment and Inability to manage Inaccurate Unreliable third information quality improvement executive documentation
Information
development, requirements Receivable inpatient revenue retention challenges Inefficient data environmental or communications party logistics (3PL) mechanisms for Indirect Medical Failure to adhere to guidelines
Management Conflicts of Interest
Lack of flexibility in testing and reporting mix Failure to minimize retention processes climate changes service providers Record keeping not error reporting Education (IME) coding rules and
Inadequate board pricing mechanism deployment of Inaccurate data costs Unclear and tools Ineffective commensurate with regulations Failure to comply
oversight of risk technology analysis leading to Governmental Loss of revenue due Failure to establish communications and Failure to properly communications the size of Loss of with regulatory
Pandemic Planning Supervision
management Failure to comply incorrect reporting intervention for to inability to meet recordkeeping Inability to maintain change management Failure to archive conduct routine foundation accreditation status Inappropriate ratio Inadequate policies, requirements
activities with preferred Inability to credit balances not third party policy consistency in strategies critical data in an capacity planning Inventory operations of interns/residents processes and
pricing implement returned documentation providing qualitative off-site location Management Liabilities due to to beds oversight Lack of adequately
Inadequate technology Lack of clarity due requirements for Inability to produce nursing services Inadequate record malpractice Lack of trained and certified
reimbursement Promotions
structure to allow for Ineffective to inadequate Financial Inappropriate records Failure to secure retention Reduction in IME Failure to disclose accountability and staff
an enterprise risk international pricing communication Performance payment and Poor morale transportable media Risk of theft of payments conflicts of interest measurement
management strategy insurance posting Failure to comply Lack of adherence amongst nurses medical supplies Loss of revenue due
process Inadequate with complex with recordkeeping Inability to capture Inappropriate Patient Safety and Patient Outcomes/ Inducements Failure to establish to improper
protection of health Inadequate regulations and laws and obligations required tax and selection of a Inadequate quality Soundness Satisfaction influencing and maintain documentation
Covenant
Inadequate or care staff operating margins requirements for legal data promotion channel controls and checks Graduate Medical prescribing supervisory controls
inappropriate risk Vision, Mission, and Rationalization and fee-for-service Lack of knowledge Training and on purchased Education (GME) practices
claims Labor Relations Unfavorable case
appetite and Values Integration Inaccurate High debt to to preserve legal Development Inability to achieve supplies Failure to identify Indicators not Inability to link mix index
tolerances estimation of patient capitalization ratio evidence promotion Covenants and manage risks to defined and Potential adverse compliance
influx Failure to comply Privacy and Data Problem objectives Inefficient detrimental to the patient safety adequately Inability to attract influence on patient performance to
Lack of risk Failure to articulate Failure to achieve Inadequate cash on with significant cost Lack of a document Inadequate policies Ineffective/ Protection Management warehousing/ foundation’s monitored and retain faculty care decisions performance
intelligent decision a vision statement desired synergy Lack of a well- hand reporting retention policy to manage labor inadequate training inventory objectives Inability to prevent management Joint Commission
making that inspires the following documented requirements relations and development management adverse events/ Poor patient Loss of Physician Licensing on Accreditation of
organization rationalization and pandemic plan Inability to access Lack of an ongoing programs Unauthorized Untimely detection processes Ambiguity in outcomes outcomes/ accreditation status Inability to link and Credentialing Healthcare
integration Investor Relations
Inadequate risk- capital at Failure to comply responsibility to Poor employee access to personally and escalation of applicability of satisfaction compensation to Organizations
related public Failure to define the reasonable rates with other supervise dispute resolution Lack of adequate identifiable problems Excessive stock covenant terms Inadequate Malpractice litigation personal
disclosures mission of the Inappropriate government mandatory retention process programs for information leading to expiration investigation of Failure to administer performance Lack of Loss of
organization assumptions and regulations of documents continued Inadequate and Providing poor of supplies and Noncompliance with incidents patient satisfaction Incomplete and infrastructure to accreditation
Medical Tourism
Inadequate usage of data Significant adverse employability of Unclear ownership untimely post- information wastage covenant terms surveys poorly documented verify physician
utilization of an Failure to articulate conditions in employees and classification of mortem actions to Inadequate patient medical records Controls and licensing and Failure to meet
appropriate risk values for collective bargaining data resolve problems Ineffective financial Inability to maintain safety and Loss of market Monitoring credentials service standards
framework conducting business Inappropriate Denials agreements Training and processes to deliver mandatory buffer soundness share due to patient for quality of care
Collections
selection of foreign Management development Lack of data Inability to solve communications in a stock for critical measures dissatisfaction Inadequate
Compliance
partners program not aligned integrity problems timely manner supplies leading to Inadequate verification of Loss of community
with business plans stock-out situations Increased regulatory establishment of physician licensing confidence
Transparency and Inability to meet Failure to track Ineffective collection and needs Inadequate media scrutiny preventative and and credentials
Pace of Change Payer Concentration
Financial Integrity foreign partner’s payer denials or strategy (e.g. In- training Applicable laws and detective controls
expectations claims rejections house versus Outsourcing of the Project Records regulations not Lack of coordination Delay in onboarding
outsourced, sale of training and Management Management Inability to adhere to identified or of care Failure to establish physicians due to
Cursory reviews of Inappropriate Inability to negotiate Inadequate Failure to monitor debts) development regulatory monitored with for monitoring and the verification
function requirements compliance Loss of trust and testing programs process
financial statements assumptions and agreement terms monitoring of foreign and appeal denied
consequential loss
and related data usage in and conditions partner’s operations claims and Noncompliance with Failure to monitor, Improper of revenue
disclosures forecasting pace of underpayments governmental communicate, and management of Failure to maintain Inability to sustain
change Adoption of unfair regulations report on project records eligibility status to control
Failure to challenge practices Failure to assess Retirement progress receive funds from improvements
Terminations Public Relations Red Flags Labor
management Inadequate denial patterns and Misappropriation of Programs Failure to maintain select sources
Charitable Status Case Management Occupational Health
assumptions infrastructure/ trends the payments Failure to obtain security
resources allocation received proper approvals
and availability and stakeholder Compliance
Inadequate Failure to quantify Inadequate Ineffective design of Failure to comply Ineffective treatment Ineffective identity Failure to comply
buy-in Information
oversight of internal Inability to meet/ the financial impact Increased bad succession planning the retirement with legal and tax of public relations Lack of oversight Lack of or theft prevention with employment
Management
and external Inability to keep up sustain eligibility of denials debts for key employees program requirements inadequate program laws and regulations
auditors with the pace of criteria to satisfy Failure to identify, Inconsistent Ineffective cost framework
change Internal Revenue Delay in initiating Litigation arising Regulatory risks prioritize, report, Lack of data messaging management Failure to establish Noncompliance with Lack of awareness
Inadequate or Service (IRS) corrective follow up from wrongful and manage project retention policies Inability to comply effective means to the Red Flags rule of employment laws
unqualified finance Inability to influence requirements for action termination Inaccurate and goals and procedures Failure to perform with health and manage compliance
organization the direction of charitable costly administration all or some of the safety regulations information Poor pay practices
change institutions process Patient Relations,
Increased claims Competitive core tasks in case
Services, and
Lack of financial denial resulting in disadvantage management Failure to establish Governmental
Failure to identify Support
expertise on the increased bad debts through intellectual Inability to fund Technology Support and effective executive sanctions/penalties
real community
Audit Committee property loss retirement programs Licensing Training dashboard views of
needs
Physician Strategy Patient Inadequate compliance issues Suspension/
and Relations Competitive Actions dissatisfaction
Failure to file Unauthorized infrastructure to discontinuation of
appropriate form physical and Failure to import/ Delayed resolution support patient Lack of data operations
990 and meet its electronic access by export technology, of IT issues services integrity in the
Religious Directives
Poor relationship Lack of or presentation and a terminated software, data, and/ information relied
between health care inadequate reporting employee or hardware Disruptions to Inability to define upon for ongoing
requirements Account Resolution Cost Reporting Building Codes and
providers and competitor operations due to patient behavior compliance
management Rates Environment
Lack of awareness physicians intelligence Sabotage by Failure to comply lack of support
Protection
about religious disgruntled or with legal Inadequate attention
directives Incorrect Inability to Imbalanced account Inaccurate cost terminated requirements Inadequate trainings to patient
assessment and implement Knowledge resolution approach reporting employees to operational staff satisfaction Rates not in Failure to comply
Disruption of monitoring of competitive actions Management (too aggressive or Failure to constantly leading to errors Compliance compliance with with State licensing
hospital operations physician’s licensing too conservative) Inappropriate skills review the and inefficiency Reporting regulatory requirements
and credentialing and knowledge to applicable requirements
Negative publicity Failure to use Inability to track prepare cost reports legislations Building design
Inability to attract appropriate tools, customers with Failure to identify Failure to monitor does not meet
Customer attrition and retain technologies, and dispute history Failure to identify Use of unlicensed and report key change in rates and licensing
physicians methods for and meet changing and inappropriate compliance-related applicable laws requirements
Inability to provide knowledge Increased bad debts cost reporting software trends
sterilization services Failure to consider management requirements Delay in or non- Inadequate safety of
financial and clinical Patient Failure to establish Inadequate submission of employees and
integration from Inadvertent/ dissatisfaction Inappropriate business partner resources to report monthly charges patients
physician groups intentional sharing presentation of the escrow agreements compliance issues reports
Corporate Policies of personally cost information effectively
and Procedures identifiable
information Noncompliance with Inadequate
Utilization of
Evidence Based governmental Cost Management/ reporting of material Medication
Clinical Trials Facilities and
Inadequate policies Medicine Failure to regulations Allocation compliance issues Management
Services
and procedures understand benefits to appropriate
of structured external
Fiduciary liability Incorrect High cost due to knowledge Inappropriate stakeholders Delay in reporting Adverse impact on
due to assumptions and diagnostics and use management allocation of IT costs utilization to patient health due to
noncompliance with data usage in of other scientific regulators medication error
policies and strategy selection methods Ineffective cost
procedures management plans Response to Incorrect data Enhanced
Higher percentage Over-reliance on Compliance Issues capture regulatory scrutiny
Poor public of unsuccessful evidence collected
perception due to clinical trials through scientific Failure to ensure Shortage of
lack of policies and methods Failure to implement data accuracy and medication
procedures Cost/time overruns a process to quality in reporting
investigate/respond
Increased likelihood Noncompliance with to compliance Loss of
of governmental/ regulatory problems promptly reimbursement from
regulatory scrutiny requirements and thoroughly government
organizations
Failure to implement
procedures, policies
and systems to
reduce the potential Drug Storage and
for recurrence Hazardous Material
Dispersal

Failure to identify
and report Adverse impact on Potential threat to
compliance issues public health and public health and
to appropriate safety environment
parties
Regulatory Ineffective
Failure to refund sanctions hazardous materials
overpayments management
program

Infection Control

Ineffective infection
control programs

Inability to control
the spread of
infection

Loss of patients

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