health care
Industries

Healthcare Fraud & False Claims

Healthcare and life sciences companies and their counsel turn to CRA for investigations and disputes relating to fraud, qui tam and false claims matters, Stark/anti-kickback, and voluntary self-disclosures. We can also serve as an Independent Review Organization or an Independent Monitor. Our industry knowledge and expertise in economics, finance, accounting, and business strategy make us uniquely qualified to assist in all phases of these matters.

We provide consultation and expert testimony in fraud and False Claims Act matters involving promotion, marketing, pricing, reimbursement, and distribution policies.  Leveraging our expertise we also evaluate allegations including kickbacks leading to medically inappropriate provision of goods and services, inappropriate referrals, up-coding, unbundling, deceptive marketing, promotion of drugs for off-label uses not approved by the FDA, fraudulent billing practices, or retention of overpayments.

Engagements

  • 01
    Behavioral health billing: The risks behind modifier inconsistencies
    Counsel to a behavioral health provider network reached out to CRA’s Forensic Services Practice after potential areas of noncompliance surfaced during a...
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  • 02
    When system logic goes wrong: Responding to compliance pitfalls in EHR implementations
    Even well-executed electronic health record (EHR) transitions can introduce silent compliance risks. Our Forensic Services Practice was enlisted after a health...
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  • 03
    Investigating whistleblower allegations that hospital revenues had been materially overstated
    The audit committee of a large regional hospital needed immediate assistance, after receiving an anonymous whistleblower complaint.
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