Compliance Advisory Services

Strategic Management is a nationally recognized healthcare compliance consulting firm that employs a team of highly qualified and experienced consultants, analysts and auditors in the field of health care. Our team of professionals can help organizations make the right decisions to build, implement and enhance their health care compliance programs.

Health care Regulatory Consulting and Analysis

Strategic Management specializes in conducting regulatory analysis that guides health care organizations through the complexities of the regulatory and enforcement environment. This includes not only interpreting the black-and-white text of the regulation but also insight on the regulatory agency’s intent and expectation. Strategic Management provides consulting and analysis in a variety of areas, including but not limited to:

  • Health care regulations, HIPAA, FCA, Stark Law, Anti-Kickback Statute
  • Regulatory and operational compliance risk areas
  • Trends in the health care industry 
  • Federal health care program requirements

Health care Litigation Support

Strategic Management attorneys provide health care litigation support service and advisory service to law firms and health care organizations on complex compliance issues. Work is performed in accordance with the independence and objectivity guidelines of the Generally Accepted Government Audit Standards. These reviews are commonly conducted under direction of legal counsel with the results being an attorney work product.

Claims Reviews

Cornelia Dorfschmid, Ph.D., leads a team of certified auditors, coders, medical professionals, statistician and compliance consultants to conduct claims reviews, including calculating overpayments and assisting in self disclosures and settlements with the government. Under Dr. Dorfschmid’s direction, our team conducts discovery and full sample audits using RAT-STATS statistical software, analyzes claims data based on coverage rules and prepares reports and presentation to health care providers, legal counsel and government officials. 

Arrangements with Referral Sources

Strategic Management assists health care organizations review arrangements with referral sources. These arrangements could implicate the Anti-Kickback Statute and Stark Law. Our health care consultants examine whether arrangements comply with applicable laws. Strategic Management also conducts arrangements with referral services as part of Independent Review Organization services and Corporate Integrity Agreement support. 

ACO Compliance Review

Strategic Management works with health care providers and managed care organizations to development and implement Accountable Care Organizations (ACOs) in accordance with the Medicare Shared Savings Program regulations. Our services include:

  • Compliance Program development and implementation 
  • Compliance Program effectiveness evaluation
  • Interim and outsourced compliance staffing
  • Code of Conduct and policy development 
  • Auditing and monitoring protocol and workplan
  • On-Going advisory and regulatory analysis

Managed Care Industry Experience

Strategic Management works with managed care organizations, including health plans, HMOs and first tier, downstream, and related entities (FDRs) on compliance with regulatory requirements. Our team of health care consultants provide:

  • Compliance Program development and implementation 
  • Interim and outsourced compliance staffing
  • Auditing and monitoring
  • FDR oversight services
  • MCO risk management
  • CMS audit preparation and remediation
  • CIA implementation and IRO services
  • On-Going advisory and regulatory analysis

SOX Compliance Health care

Strategic Management’s team of health care consultants work with organizations that must comply with the Sarbanes-Oxley Act (SOX). Our health care consultants help organizations implement the compliance program requirements and to address areas such as Board of Director’s responsibility, conflicts of interests, Code of Conduct, financial management, reporting process and audit independence.