External audits and inspections

• Rehabilitation services
• Intensive medical rehabilitation
• Interpreter assistance for persons with disabilities
• Interpretation to and from foreign languages
• Optician’s products and services covered by social assistance
• Moving and storage services covered by social assistance
• The service network of the Finnish Student Health Service (FSHS)
• The direct reimbursement procedure for medical expenses
• Taxi booking services and the direct reimbursement procedure for taxi costs
• The direct reimbursement procedure for medicine expenses
• The direct reimbursement procedure for medical transportation in emergency care and non-urgent care.

We carry out inspections of applications for reimbursement of employers’ occupational health care costs. The aim of these inspections is to ensure that the information provided in the claims is accurate, that applicants receive equal treatment, and also to determine whether the information provided meets the criteria for reimbursement. The same aims apply in our inspections of healthcare service providers who provide occupational healthcare for self-employed persons. In this way, we ensure that the resources of the earned income insurance are allocated to operations entitled to statutory reimbursement.

In connection with our inspections, we give employers guidance and advice on matters related to reimbursement for occupational healthcare, which helps to promote good occupational healthcare practices. Inspections focus mainly on applications that have not been decided. After the inspection, the application is transferred to a claims determination centre for processing.

Kela ensures that workplace funds are able to distribute benefits under the Health Insurance Act. We regularly perform inspections of workplace funds, and we provide guidance and monitor the funds’ operations.

In an inspection, we examine the administrative arrangements of the workplace fund, checking whether the accounts are up-to-date and whether Kela’s benefits advances have been used appropriately. We also review the distribution of benefits under the Health Insurance Act and evaluate various aspects of the operations, for instance whether benefit processing is running smoothly, whether benefit decisions are correct and whether procedures comply with the benefit processes.

Kela performs inspections of student restaurants that receive meal subsidies. We check if the conditions for meal subsidies are met at the student restaurant, if meal pricing is correct, if meal subsidies are billed correctly, how the food service is arranged and whether the criteria of the meal recommendation for higher education students are met.

In our inspection of the FSHS, we examine the costs eligible for reimbursement during the accounting and operating period and operations at the end of the accounting period. Costs eligible for reimbursement refer to the costs incurred in the provision of student health care.

Before and during

1. We notify the service provider, employer, workplace fund or student restaurant in advance of the audit or inspection so that they are able to prepare for it.
2. We carry out an audit or inspection either on-site or remotely (service providers, workplace funds, employers, FSHS). The meeting begins with a discussion on the objectives and implementation of the audit or inspection.
3. Representatives of the body that is being audited or inspected are always involved in the audit or inspection. Sometimes employees will also attend the meeting.
4. At the meeting, the representatives have the opportunity to ask questions. The inspectors often interview employees and observe relevant aspects of the operations. The inspectors also examine various documents and operating processes.
5. At the end of the meeting, the inspectors discuss their observations with the representatives.

Afterwards

1. After the audit or inspection, the auditors record the key findings and development proposals in their report. The findings are classified into significant and minor deviations and development proposals. The specific strengths of the body being audited or inspected are also highlighted. Such strengths may include good practices that clearly exceed the requirements of the contract, service description or instructions.
2. After the audit or inspection, the inspector sends an audit or inspection report to the audited or inspected body. A written response to the findings is requested. In its written response, the audited or inspected body must set out a plan for correcting any deficiencies brought up in the report.
3. Kela will close the audit or inspection once the written response has been received. Kela monitors the corrective measures taken.