Health Care Litigation Support

Strategic Management employs a number of attorneys, but is not a law firm that acts as an advocate on behalf of clients.  That is left to law firms.  Many law firms with health care clients, however, have found great value in using the expertise of Strategic Management in addressing sensitive compliance issues and providing health care litigation support.  They find great value in the fact that Strategic Management is able to certify all work performed is in accordance with the independence and objectivity guidelines of the Generally Accepted Government Audit Standards (GAGAS) of the Government Accountability Office (GAO). These reviews are commonly conducted under direction of legal counsel with the result being an attorney work product.

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Claims Reviews

Strategic Management’s expertise is often requested to conduct claims reviews, estimate overpayments, as well as in prepare and negotiate settlements with government agencies and their contractors.  Strategic Management is able to provide a heightened level of oversight, diligence, and sophistication during audits and reviews through evaluation and assessment of the accuracy of Medicare and Medicaid claims preparation and submission.

Many claim system reviews require the statistical rigor and methodology of the DHHS Office of Inspector General (OIG) RAT-STATS and Self Disclosure protocols. Strategic Management has significant experience and expertise in claims development, statistics, and provider claims operations. Dr. Cornelia Dorfschmid, PHD, Strategic Management Executive VP is one of the nationally recognized experts on this methodology.  She heads a team that performs these reviews in a form and manner that is presentable to the OIG and/or the Department of Justice.  Under her direction, Strategic Management is able to design and implement Discovery and Full Sample Audits using RAT-STATS and Self Disclosure Protocols, claims data analysis based on regulatory coverage rules, report preparation, and presentation to providers, counsel, and government officials. These independent evaluations are performed by recognized experts who are experienced in validating their work before enforcement officials.

Arrangements with Referral Sources

The number one regulatory and enforcement priority of the OIG and DOJ has related to arrangements organizations have with referrals sources, mostly physicians.  These arrangements often implicate the Anti-Kickback Statute and Stark Laws.  Law firms will engage Strategic Management to examine arrangements for compliance with applicable laws.   Strategic Management is able to independently assess arrangement compliance with the applicable laws and is prepared to defend its work before government agencies.

Assisting in Client Preparation for a Corporate Integrity Agreement

Law firms will often have Strategic Management assist them in preparing their clients for a Corporate Integrity Agreement (CIA), wherein the organization will have to attest and certify compliance with the Compliance Program Standards.  As the law firm works out terms and conditions of the CIA, Strategic Management positions the client to be able to make their certifications.

Another area wherein Strategic Management is able to assist law firm clients with CIAs is working to prepare them to be auditing by the Independent Review Organization (IRO).  The work of the IRO is reported to the OIG and if they fail to meet terms under the CIA it can result in additional liability and conditions.

Please get in touch with us if you have questions or would like to discuss the ways our company can help you. You can call us at (703) 683-9600 or fill out our online contact form.

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