In today’s regulatory climate, healthcare providers need targeted compliance programs to prevent and detect violations and to respond effectively when issues arise. FTI Consulting has the expertise to evaluate the effectiveness of compliance and ethics programs and to develop a proactive approach to mitigating risks. We assist our public and private healthcare clients in developing and implementing auditing and monitoring regimens designed to identify potential risk areas. We have performed this work on a proactive basis and also as an Independent Review Organization under dozens of corporate integrity agreements.
Development and Implementation of Compliance Programs
We have worked with clients across the healthcare industry 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 health care claims using statistical samples, benchmarking of client and industry data, and sophisticated electronic models.
Corporate Integrity Agreements and Other Independent Review Activities
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. We regularly collaborate with government agencies to develop analytical methodologies and reporting formats.
Risk Adjustment Operational Improvement and Compliance Assessments
We assist health plans and providers to assess and redesign work flows, policies and procedures, controls, reporting and forecasting related to Medicare Advantage and risk-adjusted populations.