Regulatory and Contract Compliance
- Engaged on behalf of a pipeline contractor to test and verify the accuracy and reliability of the costs incurred and charged in accordance with the billing provisions, of a contract to construct a major pipeline in Louisiana and Texas. We examined and tested underlying accounting source documentation supporting project costs and applied contractual billing provisions in rendering an opinion that the project billings were in accordance with the contract and that the contractor suffered damages during the project.
- Provide regulatory and compliance consulting for more than 15 hospitals and health systems in the State of Arizona. These services are designed to validate an organization’s payor mix to ensure their related reimbursement payments are made in accordance with federal regulations. The results of the validation procedures ensure hospital compliance with current regulations and typically increase overall hospital reimbursement.
- Analyzed a company’s billing and payment practices related to their patient management services provided under contract with six different state agencies. Our work was designed to analyze the contracts and determine whether the patient management company was complying with its agreements and the financial implications associated with non-compliance.
- Engaged by a healthcare provider developing facilities in AZ, NV, and CA to provide financial contract compliance services for their construction projects. Responsible for verifying the construction costs invoiced to the owner were supported by accounting source documentation and are being billed in accordance with the specific terms of the Construction Manager/General Contractor’s contract with the owner.
- Engaged by a global manufacturing, development and technology company, with significant licensed intellectual property, to provide licensee royalty compliance review services on their portfolio of IP licenses. Responsible for verifying the royalties paid were in accordance with the license terms and supported by the licensee’s financial records.
- Performed a review of a large health system’s medical education intern and resident count for Medicare reimbursement purposes. This review consisted of identifying all compensated hospital interns and residents, validation of their eligibility and education credentials, review of hospital prepared rotation schedules, review of current Medicare regulations and the computation of the final FTE count. Our final report was used to obtain the appropriate amount of reimbursement from the Medicare Program.
- Investigated the practices of a Pharmacy Benefits Manager (PBM) as it related to the PBM’s contract with a large union organization. The investigation was designed to determine whether the union was billed in accordance with its contract with the PBM. Our analysis included reviewing hundreds of thousands of prescription claims in many different markets in the United States.