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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Contract Research Organisations M&A Market
March 28, 2025
Rising cost pressures, stricter regulatory demands and advancements in emerging therapeutics are intensifying competition within the industry. These dynamics are fuelling the demand for greater efficiency in development lifecycles, creating significant opportunities for outsourced providers like Contract Research Organisations (CROs).
Healthcare Workforce Predictions for 2025
March 19, 2025
The healthcare landscape in 2025 is marked by a complex interplay of financial pressures, persistent workforce shortages, and rapid technological advancements. While healthcare providers have stabilized post-pandemic, they face shrinking revenues coupled with escalating workforce expense, which now comprise a significant portion of total expenses.
Mass General Brigham is Redefining ROI Through the Lens of its Mission to Improve Human Health
March 18, 2025
How do you fundamentally redefine “ROI”? Niyum Gandhi, CFO of Mass General Brigham, the largest employer in New England and the largest medical research organization in the world, shares about his Moonshot to do just that.
The Clock is Ticking: Why Health Plans Must Act Now to Maximize Star Ratings Before the 2026 HEI Update
March 12, 2025
The October 2026 Star Ratings release presents both an opportunity and a challenge for health plans as they navigate uncertain Health Equity Index (HEI) changes. With evolving CMS equity-focused metrics, shifting data collection requirements, and potential weighting adjustments, health plans must take immediate action to optimize their Star Ratings before potential regulatory shifts in 2027.
