Our Experience
With 26 years in the industry, we are passionate about compliance and provide a wide range of corporate compliance services.
Our Track Record
Our experience, expertise, and professional reputation in regulatory compliance is unparalleled in the health care compliance industry. We bring a broad scope and profound depth of knowledge and years of collective experience in this ever-changing environment.
Reduced Home Health Agency’s Medicare Liability from $22.5 million to $1.5 million
Represented the nation’s largest privately held home health agency as part of cost report audit conducted by the Office of Inspector General. Project outcome reduced provider’s liability from $22.5 million to $1.5 million.
Developed Compliance Program for a Nationwide Laboratory
Developed and implemented a corporate compliance program for a nationwide pathology and clinical lab that specialized in urological testing. Stemming from a “whistleblower action” related to the False Claims Act against the company, the Justice Department investigated the billing and compliance practices of the organization among other issues. In conjunction with the company’s outside legal counsel, we developed a corrective action plan as part of its overall compliance initiative which included ongoing training, monitoring, auditing and reporting. The program was ultimately reviewed in full detail by the Department of Justice and approved in accordance with the Office of Inspector General (OIG) Model Compliance Program for Laboratories.
Partnered under Medicare Drug Integrity Contractor (MEDIC)
The MEDIC is CMS’s benefit integrity contractor tasked with detecting and preventing fraud, waste, and abuse in Medicare Part C and Part D. Working on Part Medicare D, we investigated complaints and performed audits of compliance programs related to Medicare Part D payment centers, pharmacy benefits and management companies as part of the CMS Medic project.
Trained Major Health System Physicians on Compliance
Developed and implemented a corporate compliance program for nationwide diagnostic lab that specialized in urological cancer. In conjunction with the company’s law firm, we developed and implemented the organization’s corporate compliance program, trained the employees on compliance, trained the trainers and got approval from the Department of Justice on the Program.
Negotiated Debt Compromise on Medicare Overpayments
Negotiated Medicare debt compromises for healthcare providers that had been overpaid by the Medicare program, thus saving them millions. Working through the Centers of Medicare and Medicaid Services, and the Department of Justice, we effectively demonstrated what the true ability to pay and that no unjust benefits accrued to the principals. Furthermore we showed that patient access to needed services would be impaired. An integral part of the negotiations was assuring CMS and DOJ that the provider had compliance controls that would ensure future payments would be in full compliance with applicable federal requirements. As part of the process, we created compliance controls for the providers to avoid future payment issues.
Determined Compliance Program Effectiveness
Evaluated compliance program effectiveness for hospital systems, home health agencies, clinical laboratories, behavioral health entities as well as ambulance service companies.
Investigated a System-Wide Allegation of Misconduct
Oversaw an independent investigation of an allegation of wrongdoing reported through the health system’s compliance hotline. The investigation protocol entailed interviewing employees, contractors, vendors and witnesses, reviewing existing documentation, and documenting all the investigative steps beginning with the inception of the problem to the conclusion of the issue.
Performed A Compliance Audit for a Major Health System Under Federal Investigation
Performed a compliance audit for a major health system under federal investigation. The assessment identified areas of non-compliance and strengths and weaknesses of the internal controls associated with the provider’s specific risk areas. Subsequent to the audit, a remedial plan was developed that included timelines, responsibilities assigned and projected funding.
Developed Compliance Training and Education
Developed compliance training and education for various healthcare entities including the development of training content, testing, documentation of attendance and assessment of knowledge retention.
Oversaw Price Reporting for a Major Pharmaceutical Manufacturer
Oversaw commercial and Medicaid price reporting and compliance for major pharmaceutical manufacturer.
