Unethical Claims Processing Practices

Gender-Based Restrictions on Medical Procedure Claims

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Question

During a review of an insurance company's claims system, the IS auditor learns that claims for specific medical procedures are acceptable only from females.

This is an example of a:

Answers

Explanations

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A. B. C. D.

D.

The correct answer is A. key verification.

Explanation: Key verification is a type of input control that ensures that data entered into a system is accurate and complete. This control is typically used for data that is critical to the organization and must be accurate to prevent errors or fraud. Key verification involves entering data twice, and then comparing the two entries to ensure that they match. If the entries do not match, the system will flag an error and require the user to re-enter the data.

In this scenario, the insurance company's claims system is designed to only accept claims for specific medical procedures from females. This is a business rule that is enforced by the system. The system is using key verification to ensure that only female patients are able to submit claims for these specific medical procedures.

Completeness check, reasonableness check, and logical relationship check are also types of input controls, but they are not applicable to this scenario.

Completeness check is a type of input control that ensures that all required fields are completed before a transaction can be processed. This control is used to prevent incomplete or missing data from being entered into the system.

Reasonableness check is a type of input control that compares data entered into the system to expected values or ranges. This control is used to prevent data entry errors, such as entering a negative number for a field that should only contain positive values.

Logical relationship check is a type of input control that verifies that data entered into the system is logically consistent with other data in the system. This control is used to prevent errors or fraud resulting from illogical or inconsistent data entries.