Our experts examine the effectiveness of the target organization’s compliance program.

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When merger and acquisition transactions take place without a comprehensive due diligence program that focuses heavily on compliance, the parties involved in such deals--buyers and sellers alike--often find themselves with costly challenges. These challenges must be confronted either pre-closure or during the immediate post-merger integration process where ideally the combined organizations should be looking forward to a returned value that initially made the deal attractive. Moreover, these challenges can often entail more than just operational inefficiencies; instead, there can be major issues that pose a significant risk and potential successor liability.

Transaction due diligence should encompass detailed processes related to both operational/financial analysis and compliance review. Ensuring that a compliance due diligence review occurs prior to closing the deal permits the buyer the opportunity to correct issues pre-emptively and allows for a chance to adjust the transaction.

When assisting healthcare organizations in transaction compliance due diligence, our experts examine the effectiveness of the target organization’s compliance program. This examination includes a detailed analysis to identify any major regulatory compliance red flags as well as potential threats that could become more acute if not sufficiently addressed in a reasonable timeframe. Our team of healthcare regulatory experts, financial analysts, and healthcare management specialists evaluate OIG program compliance, governmental audits and investigations, financial relationships with physicians, and compliance with Stark Law exceptions and anti-kickback safe harbors.

We also perform billing and coding diligence audits, evaluating a sampling of encounters and claims to determine the accuracy rates of physician coding and documenting practices (CPT, E/M, ICD10, ‘incident to’ billing, modifier usage). Our compliance diligence audits assist in identifying any potential red flags of the target so that key decisions can be made regarding the transaction and any potential self-disclosures and repayments if necessary.

We understand that each potential transaction is unique, and the due diligence we perform informs both the viability of the deal and the future success of the newly formed or combined entities. We provide conclusions and recommendations as to current practices compared to the market, both regionally and nationally.

We also perform post-close compliance integration work through our placement of Virtual Compliance Officers.

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