BPK Global Solutions provides comprehensive audit and investigation services for Government Health Scheme programs — ensuring transparency, accountability, and scheme integrity across India.
BPK aims to become a leading provider of integrated audit and surveillance services for Government Health Insurance Schemes across India. By combining field expertise with technology-driven reporting, BPK delivers end-to-end audit solutions that protect public resources while upholding scheme beneficiaries' trust.
Our structured audit methodology covers the complete claims lifecycle — from enrollment verification to treatment validation and billing reconciliation — ensuring that every rupee disbursed under government health schemes reaches its rightful beneficiary.
Comprehensive Audit Services
BPK provides end-to-end audit services for Government Health Insurance Schemes. Our structured approach covers all audit dimensions — from medical record review to beneficiary verification — ensuring complete scheme integrity.
Medical Audit
Review of medical records, treatment protocols, and clinical appropriateness for government scheme claims.
Claim Audit
End-to-end claim verification including billing accuracy, package compliance, and documentation validation.
Hospital Audit
On-site hospital empanelment review, infrastructure validation, and service quality assessment.
Beneficiary Audit
Field-level verification of scheme beneficiaries — identity, eligibility, and treatment confirmation.
Mortality Audit
Systematic review of mortality cases to ensure clinical accuracy and prevent fraudulent death claims.
Fraud Detection
AI-assisted pattern recognition and field investigation to identify and prevent scheme fraud.
Medical Audit
Medical audit is a systematic process of reviewing medical care against established standards to improve the quality of care. BPK's medical auditors review clinical records to ensure treatment appropriateness, necessity of procedures, and compliance with scheme packages.
BPK aims to become a leading provider of integrated medical audit services, and is committed to identifying discrepancies that may involve the following scope of audit:
Scope of Medical Audit
- Duplicate or already claimed cases
- Day care procedures claimed as inpatient
- Claims filed without valid empanelment
- Inflated bills and overcharging of packages
- Clinically inappropriate or unnecessary procedures
- Non-empanelled hospital claims
- Fictitious or fraudulent beneficiary claims
- Package misrepresentation or upcoding
Claim Audit
Before finalising any payments, a thorough claim audit is performed to verify that each claim submitted under the government scheme is legitimate, accurate, and compliant with the scheme guidelines. BPK's claim audit process ensures end-to-end verification.
Claim Audit Objectives
- Verify the identity and eligibility of the beneficiary
- Confirm the patient actually availed treatment
- Validate the claimed package against actual treatment
- Check hospital billing for accuracy and over-invoicing
- Review discharge summaries and clinical documentation
- Cross-verify claims with scheme master data
Hospital Audit
A hospital audit under government health schemes ensures that empanelled hospitals meet the required standards for infrastructure, staff, equipment, and service delivery as mandated by the scheme authority.
Hospital Audit Focus Areas
- Infrastructure and facility validation
- Medical staff credentials and availability
- OT, ICU, and equipment compliance
- Patient record management systems
- Pharmacy and drug dispensing protocols
- Compliance with empanelment criteria
- Previous claim history analysis
Beneficiary Audit
Beneficiary audit involves field-level verification of individuals who have availed government health scheme benefits. BPK's trained field investigators conduct doorstep verification to confirm treatment, identity, and scheme eligibility.
Beneficiary Verification Process
- Aadhaar-linked identity verification
- Confirmation of hospital visit and treatment
- Family income and eligibility assessment
- Post-treatment health status follow-up
- Geotagged photographs of beneficiary residence
- Signed declaration and consent forms
Mortality Audit
A Mortality Audit is a retrospective audit that is conducted to review the causes and circumstances of deaths occurring within a hospital. BPK performs mortality audits to ensure clinical accuracy and prevent fraudulent or inflated mortality-related claims.
Objectives of Mortality Audit
- Whether the patient record is complete and accurate
- Whether the patient received appropriate care prior to death
- Whether the cause of death is correctly documented
- Identify any clinical deficiencies or negligence
- Cross-verify death certificate with medical records
- Field verification of death with family members
Purpose of Mortality Audit: Mortality audit helps insurers and scheme administrators understand whether mortality claims are genuine, ensures that hospitals are providing appropriate care, and identifies patterns of fraud or negligence.
BPK WORKS FOR
Insurers
Supporting insurance companies managing government health schemes with accurate and timely audit and investigation services.
Government Healthcare Agencies
Partnering with state health authorities and NHA to audit Ayushman Bharat, Arogyasri, and other government schemes.
Healthcare Service Providers (TPAs)
Assisting TPAs managing government health schemes with field verification and beneficiary audit services.
Strengthen your scheme's
integrity today.
Connect with BPK to discuss your government health scheme audit requirements and how our field expertise can help safeguard public healthcare resources.