Our clients operate in a heavily regulated industry with a constantly changing regulatory landscape. Compliance and regulatory considerations span an entire organization and lay the framework for:
- ensuring safety and compliance
- measuring quality and performance
- sharing healthcare information and data
- optimizing workforce
- hiring, credentialing and enrolling providers
- tracking facility access and security
Multiple agencies govern compliance within the healthcare realm including DOJ, OIG, FDA, CMS, TJC. Consequences for non-compliance with applicable regulations include substantial financial penalties such as fines, lawsuit settlements, and exclusion from government programs, such as Medicaid and Medicare.
Given the financial and reputational impact of compliance issues, A&M clients benefit from HIG’s compliance experts to assess the range of risk and regulatory exposure and to quantify the ROI of a comprehensive compliance implementation against impact of regulatory fines. Our HIG Compliance and Regulatory service is led by skilled, widely respected former compliance executives and high-ranking government officials with unique, firsthand experience and perspectives. With the capacity to fully assess a healthcare organization’s exposure areas, our team is equipped to provide implementation roadmaps for improvement and reorganize compliance and legal departments to maximize business functions.
RELY ON US FOR HELP WITH:
| Compliance and Quality Program Assessment and Operation Enforcement and Exposure Review and Solution Design |
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Privacy and Security Program Review and Operations |
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- Assess Compliance Program Effectiveness
- Identify Compliance and/or Quality Program Gaps
- CCO Engagements
- Custom Compliance Education and Training
- Board of Director Education and Advice
- Reporting Relationships, Roles and Responsibilities
- Conflict of Interests
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- Program Design and Implementation
- Privacy and Security Audits
- Risk Assessments
- Breach Evaluation and Response
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| Government Investigations and Settlements |
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Fraud, Waste, and Abuse Investigations |
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- Monitor Corporate Integrity Agreements (CIAs) and Assist with Reporting Activities
- Develop and Implement Corrective Action Plans
- Repayment Analysis
- “Ability to Pay” Presentations
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- Assist with Internal Investigations and Self-Disclosure Protocols
- Regulatory Agency Interfaces and Reporting
- Auditing and monitor for compliance with False Claims Act and Fraud, Waste, and Abuse Regulations
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| Licensing and Accreditation Services |
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Interim Management |
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- Auditing and monitoring for compliance with Medicare Conditions of Participation and Accreditation Standards
- Accreditation Survey Preparation and Response (e.g., NCQA, URAC, JCAHO, AAAHC)
- Quality Assurance and Performance Improvement Plan
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- Chief Compliance Officer
- Chief Privacy Officer
- Chief Security Officer
- Chief Risk Officer
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| Process, Redesign, and Implementation Services Management Advisory Services |
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Risk Assessment and Management Operational Due Diligence |
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- Operational Performance Improvement Strategies
- Governing Boards and Senior Management Collaboration
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- Risk Management and Process Improvements
- Liability/Loss Mitigation
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| Transaction Support |
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- Pre and Post Acquisition / Merger Due Diligence
- Integration Support
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The Affordability Agenda: Inside Healthcare's Cost Crisis
July 14, 2026
What will it take to bend the healthcare cost curve? Jay Khosla, Chief Government Affairs Officer at Humana, joins A&M's Craig Savage and David Shulkin, M.D. to examine the financial realities shaping healthcare's future and discuss how transparency, value-based care and responsible AI adoption can help drive better outcomes.
Bridging Care and Strategy: Luis Garcia's Journey to Leader of RUSH Medical Group
July 7, 2026
Healthcare's biggest challenges won't be solved by clinicians or administrators alone. Luis Garcia, M.D, FACS, FACHE, President of RUSH Medical Group joins A&M Healthcare Industry Group's Chris Smedley and David Shulkin, M.D. to discuss why collaboration across clinical and executive leadership is essential to improving care, strengthening organizations and preparing future healthcare leaders.
Value-Based Care: From Experimentation to Enterprise Discipline
June 24, 2026
As health systems approach another round of the Center for Medicare and Medicaid Innovation (CMMI) program milestones,
one reality is clear: Value-based care (VBC) has fundamentally changed. Years of margin pressure and market volatility
have driven many systems to step back from risk sharing with payers to stabilize their balance sheets.
Episode 2: Don Antonucci, President and CEO, Providence Health Plan
June 16, 2026
In this episode, Don Antonucci, President and CEO of Providence Health Plan joins A&M Healthcare Industry Group's Craig Savage and Mike Epstein to share how health plans can maintain stability while delivering value to members.
