Health Care Regulatory Matters
Detecting and preventing healthcare fraud and abuse has received increased focus and priority from federal and state law enforcement since the enactment of the Medicare and Medicaid programs on July 30, 1965. Government investigators, auditors and prosecutors are committed to the financial integrity of these programs and have developed sophisticated strategies to detect and prosecute improprieties. During the second half of its 2006 fiscal year, the Department of Health and Human Service Office of the Inspector General (OIG) reported $38 billion of savings and expected recoveries.
Health care providers develop plans to ensure that their companies are compliant with laws, rules, regulations and good business practices, and to protect themselves from an appearance of impropriety and mitigate their liability and exposure. An effective compliance program established and implemented in accordance with the Federal Sentencing Guidelines is a key to strengthening the integrity of a health care provider.
Health care regulatory matters include the following:
- Corporate compliance
- Government audits and investigations
- Provider self disclosures
- Corporate integrity agreements
- Certification of compliance agreements
- Reimbursement rate disputes
Health care regulatory matters services help managers manage risk, detect errors, report detected errors, react and respond to third party audits and investigations, implement remedial steps to respond to investigations and fix broken systems, processes, procedures and controls. I have diversified health care experience as a professional advisor, and working for a health care provider and a government regulator.
Health care regulatory matter services include the following:
- Investigation, verification and quantification of errors
- Audit and investigation representation
- Systems and internal control improvements
- Corporate compliance program assessment
- Corporate integrity agreement assessments
- Certification of compliance agreement assessments
Health care regulatory matters solutions illustrate examples of actual health care regulatory matters business advisory engagements.
Contact Ralph P. Perrino, CPA, LLC for more information on litigation consulting services.