Services
Healthcare Disputes
Resolving disputes across the global spectrum of healthcare
In recent years, the healthcare industry has faced intensifying regulations and shifting economic pressures that are increasingly difficult for organizations to navigate. In this environment, healthcare providers, payers, and technology companies have become frequent targets of litigation and investigations as heightened scrutiny of the sector has led to a greater risk of allegations of wrongdoing.
Ankura’s healthcare disputes, compliance, and investigations professionals routinely serve as expert testifiers and consulting experts in litigation and arbitration matters involving clinical, financial, and operational issues across the full spectrum of the healthcare industry. Ankura also routinely helps healthcare clients and their counsel in conducting internal investigations and in other complex litigation support roles to quantify potential impact related to the facts and allegations of a dispute.
Offerings
- Damages Quantification
- Payer/Provider Payment Disputes
- Out-of-Network Payment Disputes
- Billing and Coding Reviews
- Risk Adjustment/Risk-Based Payment Disputes
- Benefits/Coverage Disputes
- Operations and Claims Adjudication Processes, Systems, and Industry Standards
- Medical Necessity & Length of Stay Evaluations
- Class Action Certification and Exposure Analytics
- False Claims Act, Stark Law, Anti-Kickback Lawsuits
- Pharmacy / Pharmacy Benefit Managers (PBM) Payment Disputes and Operational Excellence
Ankura's team of experts has been working with Pharmacy Benefit Managers (PBMs) over the past two decades. Our team has a deep understanding of the PBM industry and has assisted PBMs in litigation, operations, audit, therapeutics, compliance, and advisory engagements. No matter the size of your organization, Ankura is equipped to provide tailored solutions that enhance your operational efficiency and compliance integrity.
How Ankura Can Assist:
- Litigation (Privileged Consulting, Damages & Economic Modeling, Expert Witness)
- Payer Assessments (Medicare Part D, Medicaid, Commercial, TRICARE)
- Data Analysis and Claims Adjudication Evaluations
- Operational and Clinical Performance
- Compliance and Governance Programs
Our Latest Thinking
The Ankura Difference
Ankura’s diverse team combines in-depth industry knowledge of the standards and regulatory requirements surrounding medical billing and coding, benefit administration and coverage, and claims processing and payment with exceptional skills in data analytics, statistical methods, and exposure assessment to help companies navigate the complex challenges caused by disputes. Our professionals include former industry executives, federal prosecutors, and health plan compliance officers. Our team has been closely involved in high-profile issues facing life sciences and healthcare organizations over the past few decades.
Key Contacts
- Mary Beth Edwards
Senior Managing Director
Washington, DC
- Jeff Nielsen
Senior Managing Director
Washington, DC
- Dorothy DeAngelis
Senior Managing Director
Phoenix, AZ
- Matthew Ryan
Senior Managing Director
Washington, DC
