CRA Forensic Services professionals were retained to assist a multi-state hospice company respond to a government investigation into alleged violations of the False Claims Act and the Anti-Kickback Statute, including whistleblower allegations of medically unnecessary long lengths of stay. As part of our assessment, we obtained, aggregated, and normalized numerous patient and claim data files, including data gleaned from the Relator’s Complaint, so that we could review patient care holistically, including analysis and trending across patients, providers, states, diagnosis codes, etc. We reverse-engineered how the Government designed its sample population to more precisely identify the Government’s compliance focus, and to reveal other risk areas for review. Finally, we constructed a powerful damages model to inform potential defense strategies.
The team was led by CRA Forensic Services Leader and Vice President Kristofer Swanson, with invaluable assistance from Patricia Peláez, Amanda Kight, and our network of highly credentialed healthcare clinicians and coders.