Healthcare Compliance & Litigation

Protecting your organization from regulatory exposure begins with a strong, proactive compliance foundation. Our team of healthcare consultants conducts targeted readiness assessments that evaluate your alignment with the False Claims Act (FCA), the Anti‑Kickback Statute (AKS), and Medicare and Medicaid fraud and abuse requirements. We help organizations understand where vulnerabilities may exist within billing, documentation, reimbursement and operational practices that could trigger government scrutiny or enforcement.

Our Fraud and Abuse Readiness services include:

• Readiness assessments covering FCA, AKS and Medicare and Medicaid fraud risk areas
• Evaluation of policies, procedures and monitoring processes
• Review of staff training and compliance education programs
• Identification of vulnerabilities and prioritized corrective actions

Medical coding audits are essential for ensuring compliance, accuracy and revenue integrity within healthcare organizations. We provide both prospective audits, which evaluate coding accuracy and documentation before claims are submitted, and retrospective audits, which review claims after submission or payment to identify errors, compliance issues and opportunities for improvement. Our focus areas include:

• CPT, HCPCS and ICD‑10 accuracy
• Documentation quality and medical necessity
• Medicare Advantage and HCC compliance
• Inpatient DRG validation
• Risk mitigation and revenue integrity

We evaluate billing, documentation and regulatory adherence across Medicare, Medicaid and commercial payers. We review your policies, monitoring activities and training programs through the lens of OIG’s seven elements of an effective compliance program, identifying gaps that could create legal or financial risk. The result is a clear roadmap that strengthens organizational safeguards, supports ethical operations and positions your team for long-term compliance success.

Our team identifies exposure to the False Claims Act, pinpoints overpayment risks and strengthens compliance programs through:

• Full billing, documentation and regulatory reviews
• Policies and procedures gap analysis
• Compliance program development

Our healthcare consulting and forensics teams leverage advanced analytics and deep industry expertise to uncover actionable insights from complex data sets. We help providers, payers and legal teams transform raw information into strategic decisions that drive compliance, efficiency, and financial integrity. From mining claims and EHR data to preparing compelling visual exhibits, we ensure accuracy and clarity at every stage.

Accurate valuations provide attorneys with the critical insights needed to support negotiations, litigation and strategic decision-making. These services help ensure fair market value determinations, mitigate legal risk and uphold compliance with healthcare-specific standards.

We deliver defensible healthcare valuations for disputes, transactions and compliance needs. Services include:

• Fair market value for healthcare transactions
• Regulatory compliance expertise
• Damage and loss calculations
• M&A valuation, due diligence and post deal support
• Valuations for healthcare entities and strategic planning

In today’s complex healthcare environment, financial disputes and compliance challenges require precise, defensible calculations. Windham Brannon’s healthcare consulting and valuation teams combine deep industry knowledge with advanced analytical tools to deliver accurate assessments that stand up to regulatory and legal scrutiny. Whether you’re navigating litigation, insurance claims or compliance audits, we provide clarity and confidence in every calculation. Our expertise includes:

• Lost profits and business interruption
• Economic damages modeling
• Asset and business valuation for litigation
• Insurance claim calculations

We help healthcare organizations navigate the complexities of fraud‑related scrutiny with expert support grounded in regulatory, clinical and billing expertise. Our team identifies risks tied to coding accuracy, documentation, medical necessity and billing practices—areas frequently examined in governmental and payor‑driven investigations.

Our Healthcare Fraud Investigation Services Include:

• Targeted assessments focused on fraud‑related risk areas, including coding, documentation, and billing patterns.
• Evaluation of internal controls, policies, and monitoring processes to identify potential vulnerabilities.
• Review of staff training and compliance education to ensure alignment with fraud‑prevention requirements.
• Clear, prioritized corrective actions to strengthen your compliance posture and reduce investigation exposure

Expert witness testimony plays a critical role in navigating complex healthcare compliance disputes. Attorneys rely on our seasoned experts to interpret Medicare, Medicaid and commercial payer requirements, assess organizational practices and provide objective opinions that withstand legal challenges.

Our experts provide objective opinions and testimony on coding, billing, medical necessity and compliance program standards. Support includes:

• Claims analysis and evidentiary preparation
• Policy and process improvement guidance
• Independent, defensible opinions
• Regulatory interpretation
• Data driven forensic analysis