Healthcare Compliance

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. The implementation of an effective compliance program is one strategy that providers, payers, and life sciences organizations have used to avoid and/or mitigate enforcement risk. 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. We assist organizations with both proactive measures to prevent fraud and other wrongdoing. We understand how to defend organizations that 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 scrutiny.

Our Solutions

Compliance Program Development and Implementation

As the federal enforcement agenda evolves, it is critical that healthcare organizations ensure that their compliance programs meet government expectations and industry best practices.

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Compliance Program Effectiveness Assessments

Organizations must ensure that their programs are effective to root out waste, fraud, and abuse.

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Compliance Officer and Staff Outsourcing Services

It is critical that organizations are continually staffed with individuals with broad compliance expertise at all times.

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Development and Implementation of Compliance Training

Ankura has developed (and delivered) innovative compliance training and education for new hires, integration onboarding, annual compliance expectations, and corporate integrity agreement corrective actions.

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Risk Assessment and Compliance Audit Services

Ankura has significant experience conducting risk assessments for health care providers as well as advising, designing, and executing on (if needed) compliance auditing plans.

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Documentation, Coding, and Billing Auditing and Monitoring

Ankura provides a full range of certified coders and decades of experience conducting coding and billing audit in every health care setting.

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Compliance-Related Investigation and Corrective Action Plan Services

Ankura provides a team of expert investigators as well as experience designing thousands of corrective action plans.

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Independent Review Organization Services

Ankura’s team has effective approaches to monitoring projects which satisfy health care organizations as well as regulators.

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HIPAA Privacy Assessments

Ankura offers a wide variety of HIPAA privacy services, including a proprietary HIPAA privacy assessment tool and method that has been utilized by some of the country’s leading health systems.

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Acquisition Due Diligence

Ankura conducts compliance due diligence so that organizations have a sense of the risk they are taking on and develop strategies to mitigate future risk and liability.

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