The Healthcare Industry is ripe with opportunities to defraud both providers and payers out of money and services that are already in short supply. The General Accounting Office has estimated that fraud accounts for at least 10% of the Nation’s healthcare spending, which equates to over $100 billion annually. Further, cuts in reimbursement programs like Medicare and Medicaid as well as continually increasing costs add pressure to management to take drastic, and sometimes illegal, measures to boost profits and cash flows. The professionals at SMART understand and have experienced many of the issues that lead to healthcare fraud, and are committed to assisting our clients in preventing, detecting, and investigating these incidents. Whether it’s developing a deterrence system, starting a corporate compliance program, or investigating a known occurrence of fraud, SMART has the expertise to provide the answers and recommendations senior management and legal professionals need.

Specific examples of services that we can provide include:

• Damage calculations, such as compiling exposure levels from fraudulent billing allegations
• Assisting in the drafting, implementations and reporting requirements of Corporate Integrity Agreements
• Assisting in settlement negotiations with government agencies or payers
• Investigation of "hotline" reports
    - Initial investigation of patient abuse issues
    - Investigation of reports of mismanagement of programs or subsidiaries
    - Initial investigation of reports of Human Resource issues/violations
• Defense of false claim allegations
• Billing compliance reviews
• Reviews of recruitment procedures, and other business process reviews related to anti-kickback violations
• HIPAA compliance reviews