Payers operate in a complex and ever-changing regulatory environment. An increasingly litigious marketplace. Investigations of fraud or non-compliance can result in serious consequences such as business disruption, damaged reputation, diminution of shareholder value, strained relationships with business partners or regulators, significant fines and civil and criminal liability. Dealing constructively with investigations and disputes requires an understanding of complicated legal structures and regulatory and accountability requirements. Handling discovery requests poses a major challenge. A timely, adequate response to such requests demands having the proper oversight, controls and monitoring in place.
Allegations of fraud and abuse are on the rise, which are perhaps exacerbated by a tough economy. Complex business arrangements such as outsourcing, partnerships and external alliances raise payer risk profiles. You face a heightened risk of litigation and investigations. The need for well-planned incident response and remediation has never been more critical.
Handling litigation and investigations cooperatively and professionally can improve their outcomes.
We provide consulting, forensic accounting, e-discovery and forensic technology services to attorneys and other parties involved in litigation, arbitration, mediation, and other dispute resolution forums. Our specialty practice areas include breach of contract claims, business interruption, investigation services, intellectual property disputes, construction disputes, securities fraud, economic and financial analysis and insurance claims services.
When confronting investigations or litigation, you should enlist additional resources and special expertise to help you document and defend your business processes and practices.
Our forensic services team includes forensic accountants, economists, statisticians, investigators, forensic technologists, insurance claims specialists and government contracting experts. For payers facing government or corporate investigations, our interdisciplinary teams can apply financial expertise, economic acumen and investigative skills to provide accurate intelligence and identify admissible evidence.
Subject matter specialist
US Healthcare Payer Practice