In an environment with increased Government scrutiny and changing regulatory landscape, healthcare institutions and their Counsel are faced with the challenge of operating an efficient and successful organization, while maintaining an effective compliance program. Complex, onerous and costly investigations, and increased whistleblower actions have led to a significant increase in the number of allegations, litigation and dispute resolution actions. These allegations trigger regulatory scrutiny with substantial monetary settlements and negative publicity all requiring external assistance of experts that have a thorough understanding of healthcare and strong functional expertise in regulatory compliance and litigation matters.
Compliance and Litigation support areas include:
- Compliance Program Development and Implementation
- Compliance Program Assessments
- False Claims/Qui Tam Investigations
- Anti-Kickback Statute (AKS) Investigations
- Fraudulent Billing Investigations
- Complex healthcare claims review (underpayments/ overpayments)
- Billing and Coding Audits (State/Federal level)
- Clinical Documentation Reviews and Financial Impact Analysis
- Medical Necessity Reviews
- Corporate Integrity Agreements (Negotiations and Independent Review Organization Services)
- Payer/Provider Litigation: Damage Estimates/Calculations
- Out-of-Network Billing Reviews
- Staffing and Training Needs: Compliance, Coding and Billing
- Voluntary Self Disclosure Analysis
- Internal Investigation Support
- Deposition and Trial Strategy Assistance (case analyses and attorney work product development)
- Expert Testimony
When efforts to fix compliance are failing, KHC can help mitigate your risk and resolve operational issues.
KHC works closely with providers and their internal / external Counsel on various discovery, case preparation, data and document analysis with the necessary tools to assist in preparing and managing cases, including Expert Testimony. In cases with critical deadlines, voluminous records, and complicated issues, we provide you with support and solutions.
