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Services to Help you Succeed in Every Part of Your Operations
Working on behalf of federal and state government agencies, we can help ensure that Medicare and Medicaid providers receive only what they are entitled to under federal and state laws.
- Compliance: Field audits, rate setting and cost settlements for nursing homes, hospitals, federally qualified health clinics, rural health clinics and intermediate care facilities for the mentally retarded.
- Consulting: Development of inpatient and outpatient hospital payment systems, rebasing and recalculation services, and the development of strategies to maximize federal funding.
We’ve been working with federal investigators since the 1990s to uncover fraud and abuse in health care programs. High profile projects include the United States Attorneys’ Offices, the Federal Bureau of Investigation and other Federal enforcement agencies.
A variety of audit and evaluation techniques are used to provide an objective assessment of your organization’s program performance. We can help you examine the achievement of desired results; the effectiveness of programs, activities, and functions; compliance with laws and regulations; and the economy and efficiency with which resources are acquired and used.
A health benefit plan audit can result in reduced claims expense and improved service to participants. Customized audit plans can include a review of prescription drug claims and medical claims.
A working knowledge of industry practices allows our professionals to unravel the most complex parts of health plans, including the organizational and operating structures employed by large affiliated group corporations, industry practices related to the application of administrative overhead rates, and reporting of affiliate transactions.