The healthcare regulatory environment is constantly changing and becoming more complicated. New laws, new regulations, and government guidance documents make it difficult to keep up with the changes healthcare organizations face every day. To make matters even more challenging, federal and state enforcement agencies such as the Department of Justice (DOJ), the Department of Health and Human Services Office of the Inspector General (OIG), the Federal Bureau of Investigation (FBI) and even the Centers for Medicare and Medicaid Services (CMS) have pursued an aggressive enforcement agenda putting healthcare providers, payers, and life sciences organizations on the defensive. One strategy that providers, payers, and life sciences organizations have used to avoid and/or mitigate enforcement risk, is the implementation of effective compliance programs. The elements as to what makes a compliance program effective may vary from one organization to the other; but one thing is abundantly clear, the government has no plans for decreasing its enforcement initiatives and in fact, federal agencies have pursued investigations and fines/penalties against companies as well as the board members and senior officers of companies because they may have allowed wrongdoing to occur.
Ankura is poised to address these and other compliance-related issues in a variety of ways. Our professionals consist of individuals who have worked as chief compliance officers in large and complex organizations and they know how things work “on the inside”. In addition, our compliance team consists of industry experts who deeply understand the complex issues that give rise to investigations and settlements. They assist organizations with both proactive measures to prevent fraud and other wrongdoing. They understand how to defend organizations who are pursued by government agencies. Our former prosecutors who enjoy positive relationships with the enforcement agencies, data experts, and investigators also understand how to protect organizations against government wrath.
As the federal enforcement agenda evolves, it is critical that healthcare organizations ensure that their compliance programs meet government expectations and industry best practices.
Organizations must ensure that their programs are effective to root out waste, fraud, and abuse.
It is critical that organizations are continually staffed with individuals with broad compliance expertise at all times.