Healthcare Compliance & Litigation Support Frequently Asked Questions
What types of issues may require a coordinated healthcare compliance and litigation response?
Matters may begin with a billing concern, payer inquiry, hotline report, repayment question, subpoena, or government investigation. A single issue can involve legal, financial, operational, and reputational risk, as well as coding, billing, reimbursement, documentation, investigation, and regulatory considerations.
What support may be needed during a government or payer audit?
Support depends on the finding and can include documentation and coding review, statistical analysis, overpayment calculation, and appeal assistance. Some matters also require self-disclosure assistance, corrective action planning, or independent review. The work should address both the underlying issue and the evidence needed for the response.
What can a compliance program effectiveness assessment cover?
An assessment can examine how the program is structured and carried out, including work plans, education, physician-contract processes, and supporting documentation. Findings can inform policy evaluation, corrective action, and ongoing monitoring. The objective is to understand how the program operates, not merely whether a list of program elements exists.
When can forensic accounting be useful in a healthcare matter?
Forensic accounting may be useful when a healthcare organization is addressing allegations of fraud, financial irregularities, disputed transactions, or other questions requiring focused financial analysis. PYA’s services include internal investigations, asset tracing, financial analysis, expert testimony, transaction due diligence, and financial fraud prevention.
Which matters may call for healthcare litigation support or expert witness services?
Healthcare litigation support may be appropriate when a dispute or investigation depends on complex healthcare financial, operational, or regulatory issues. This can include alleged Stark Law or Anti-Kickback Statute violations, financial mismanagement, government investigations, or matters requiring expert analysis of reimbursement, coding, billing, or other healthcare-specific information.
