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Healthcare Compliance

Navigating today’s complex healthcare regulatory environment

The healthcare regulatory environment is constantly in flux. The volume and complexity of new laws, regulations and government guidance make it increasingly difficult for healthcare organizations to remain compliant and aligned with best practices. To make matters even more challenging, government agencies have pursued an aggressive enforcement agenda that has put healthcare providers, payers, and life sciences organizations on the defensive. As a result, leading healthcare organizations are implementing robust compliance programs as proactive measures to protect their operations and reputation.

Our team is focused on helping healthcare clients build, enhance, strengthen, and implement world-class compliance programs. Having worked directly with numerous health plans that hold commercial and government contracts (Medicare Advantage & Part D, Medicaid, TriCare, and the Affordable Care Act), we are well-equipped to partner with payers, providers, pharmacies, and medical services organizations (MSOs).


Compliance Program Development & Implementation

Our team has helped hundreds of healthcare organizations implement and enhance their compliance programs. We have a robust library of policy and procedure templates and tools to assist healthcare organizations with the efficient implementation of comprehensive compliance programs.

  • Delegation Oversight Programs
  • First-Tier, Downstream, and Related Entities (FDR) Oversight Programs
  • Operations & Payment Compliance
Compliance Program Effectiveness Assessments

Our team of compliance experts partners with our clients to conduct regular assessments of their compliance programs and develop action plans for enhanced effectiveness.

  • Compliance Due Diligence of Acquisition Targets
  • Fraud, Waste, & Abuse (FWA) Assessments
Risk Assessments & Program Audits

Our team simulates sweeping government audits to help clients develop remediation and corrective action plans that enhance their compliance resilience.

  • Medicare & Medicaid Operational Readiness Audits
  • Risk Adjustment Data Validation (RADV) audits
  • Vendor Audits
  • Health Information Privacy & Security Program Assessments
Physician Transaction Compliance

We help design processes and systems to mitigate the risks of violating Stark and anti-kickback statutes and develop auditing methodology that allows our clients to validate, on an ongoing basis, that their system is working.

  • Stark Law & Anti-Kickback Statute Reviews
  • Audit Methodology Development
Billing & Coding Assessments

Ankura’s coding team consists of experienced certified coders and clinical documentation specialists who perform coding compliance work for hospitals, physicians, and a variety of healthcare providers.

  • Process Reviews, Clinical Coding Assessments,
  • Clinical Research/Clinical Research Billing Program Reviews

Our Latest Thinking

The Ankura Difference

Our team has worked as chief compliance officers who know how large and complex healthcare organizations operate. In addition, our compliance team includes industry experts who deeply understand the complex issues that give rise to investigations and settlements. This extensive experience has contributed to our proven capabilities to evaluate compliance systems, processes, policies, and procedures for healthcare providers while providing unique insights into government expectations for effective and well-documented compliance programs.

Let’s Connect

We solve problems by operating as one firm to deliver for our clients. Where others advise, we solve. Where others consult, we partner.

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