Risk, Controls and Compliance

• HIPAA privacy and security
• Medicare Advantage and prescription drug programs
• State laws and regulations, such as any-willing-provider mandates
• Tax compliance issues
• Accreditation reviews
• Government and corporate investigations

Compliance with regulatory requirements and standards of ethical behavior should be a proactive effort. Painful experience shows that compliance programs that emphasize prevention, detection and punishment of ethical and legal lapses have proven to be much less effective than programs based on clearly defined organizational ideals and personal aspirations. Instead of relying on laws and regulatory requirements to motivate ethical behavior, payers need to create a values-based work environment and integrate ethical principles and standards of conduct into the organizational culture.

How we can help you

PricewaterhouseCoopers can help you stay compliant with regulations for corporate governance and healthcare-specific policies and practices. We can help you preserve and enhance your most vital corporate asset — your reputation for integrity.

• Actuarial and underwriting
• HIPAA
• ICD-10
• Internal audit
• Investigations
• Litigation response
• Medicaid
• Medicare
• Privacy and security
• Risk identification and management
• Sarbanes-Oxley
• State regulators