Healthcare

  • Providing audit and tax services for healthcare providers, including hospitals, nursing homes and specialized care entities.
  • Advising governing bodies, committees and senior management of healthcare institutions on their role in governing and overseeing financial statement fraud and regulatory compliance.
  • Analyzing and determining the economic viability of a variety of healthcare entities in connection with acquisitions and dispositions.
  • Investigating, providing forensic accounting and expert testimony in a criminal fraud matter brought against the former CEO of a community health center by the US government.
  • Analyzing the appropriateness of audits performed by an accounting firm, along with Medicare reimbursement trends and issues, in connection with the failure of a hospital.
  • Investigating and providing expert testimony over the misuse of grant money obtained by a large teaching hospital.
  • Establishing the fair price of a medical service in a variety of matters for both healthcare providers and third-party administrators.
  • Investigating allegations of misconduct by a rogue employee at an academic medical center regarding theft of insurance refunds.
  • Performing a detailed “scenario based” fraud risk assessment for a nationwide long-term inpatient and outpatient rehabilitation hospital, by developing the financial significance and probable likelihood of occurrence of fraud under scenarios derived through focus groups and interviews throughout the organization.
  • Developing and implementing an anti-fraud program addressing all provider aspects, from financial statement fraud to regulatory compliance, for a nationwide long-term inpatient and outpatient rehabilitation hospital, surgical care center, and diagnostic provider.
  • Conducting analysis and reporting findings in connection with a large hospital’s dispute of a pending Certificate of Need.
  • Conducting an analysis to determine whether the charges submitted by a hospital were reasonable and customary as related to supplemental medical insurance.
  • Evaluating and identifying inaccuracies within the financial statements of the target company during an acquisition process of an MRI center.
  • Valuing health insurance claims for a teaching hospital located in Tennessee.
  • Determining the price of current and future medical needs in a malpractice claim and advising a children’s hospital on available financial alternatives.
  • Ascertaining the cost of a drug submitted for reimbursement and advising a national pharmaceutical company through the related drug pricing investigation.
  • Providing expert testimony in state court on behalf of a state funded hospital being accused of misusing state funds received.
  • Providing expert testimony in a derivative action arising out of a Medicaid fraud and abuse drug pricing investigation for a large pharmaceutical company.
  • Analyzing and testifying on the customary and reasonable nature of a healthcare provider’s compliance program.
  • Evaluating fraudulent conveyances and the zone of insolvency of a purchaser of blood plasma products who failed to make payments under the terms of a contract.
  • Evaluating claims of false advertising and unfair competition filed against the defendant involving generic drugs and the issue of being therapeutically equivalent.
  • Soliciting bids, advising the Trustee and liquidating an acute care hospital located in the State of Mississippi.
  • Providing expert testimony in an employment dispute with undertones of healthcare fraud and abuse.
  • Performing due diligence on health care facilities on behalf of financial institutions in an effort to assist with both underwriting and the investigation of other available financial remedies.
  • Conducting an analysis of billings submitted to Medicare to assess the cost of services and determine whether goodwill was included in charges by the target company. Client was a home health care company who was in the process of acquiring a staffing services company.
  • Conducting an assessment of a provider’s processes used for medical billings to determine if the provider was in compliance with its own procedures.
  • Analyzing whether a company accurately and appropriately enrolled Medicare candidates into a Medicare prescription drug plan by reviewing trends of number enrolled and the resources used by the company to conduct the enrollment process.
  • Evaluating lab billings by a medical center regarding the bundling and unbundling of charges; working with nurses who reviewed the lab reports and compared tests ordered to lab tests actually run.
  • Assisting a subsidiary of a large international bank with its loan and mezzanine investment underwriting of underperforming healthcare entities.
  • Valuing inpatient and outpatient healthcare entities.