Regulatory & Compliance

Markets Served

In today’s regulatory climate, healthcare providers need targeted compliance programs to prevent and detect violations and to respond effectively when issues arise. Public and private healthcare clients rely on our expertise to evaluate the effectiveness of compliance and ethics programs and to develop a proactive approach to mitigating risks. Our experts can assist in developing and implementing auditing and monitoring regimens that identify potential risk areas. We have performed this work on a proactive basis and as an Independent Review Organization under corporate integrity agreements.

How We Help

Our multidisciplinary group of industry-experienced compliance and investigative professionals works collaboratively to bring the right mix of experience and skills to your particular issues. This approach combines the skills of industry specialists with those of compliance and strategic communications experts, investigative professionals, forensic accountants, computer forensic specialists, and electronic evidence and technology consultants. These are supplemented, as necessary, with experts in healthcare provider and payer matters.

Engage for our expert services that include:

Compliance Program Effectiveness

Across the healthcare industry, clients engage us to develop and assess the effectiveness of comprehensive...

Across the healthcare industry, clients engage us to develop and assess the effectiveness of comprehensive compliance programs. This involves strengthening internal monitoring and auditing processes; advising on policies, procedures, and standards of conduct; building effective training programs and lines of communication; and performing detailed reviews of healthcare claims using statistical samples, benchmarking of client and industry data, and sophisticated electronic models.

Corporate Integrity Agreements and Independent Review

We have performed independent review and monitoring activities for a wide variety of healthcare clients, including...

We have performed independent review and monitoring activities for a wide variety of healthcare clients, including serving as Independent Review Organization (IRO) and Compliance Expert as part of corporate integrity agreements. Government agencies also regularly engage us to help them develop analytical methodologies and reporting formats.

Risk Assessment

Health plans and providers seek our assistance to assess and redesign workflows, policies and procedures,...

Health plans and providers seek our assistance to assess and redesign workflows, policies and procedures, controls, reporting and forecasting related to Medicare Advantage and risk-adjusted populations.