Healthcare fraud & abuse

PwC combines investigative techniques and deep industry knowledge to assist companies and their counsel during investigations instigated by Department of Justice (DOJ), Office of the Inspector General and state enforcement agencies, as well as through Qui Tam (whistleblower) actions. Experienced in all phases of the internal investigative process, our interdisciplinary teams evaluate and help companies solve complex healthcare fraud issues, as well as actively assist counsel develop investigative strategies.

Our healthcare fraud experience includes:
  • Analyzing and managing data
  • Benchmarking to industry standards
  • Medical record coding and documentation review
  • Conducting internal investigations
  • Providing regulatory and industry insight
  • Quantifying financial impacts
  • Developing, enhancing and implementing compliance programs
  • Assistance with voluntary disclosure processes
By engaging our services, PwC healthcare clients are able to:
  • Create internal controls that mitigate the risk of future improprieties
  • Implement effective compliance programs that lower potential fines
  • Enhance their reputation and credibility with the government and marketplace
  • Preserve the evidentiary value of electronic information
  • Validate their legal positions