health provider consulting



Risk, Regulatory & Compliance

Risk, Regulatory & Compliance Solutions

Guidehouse brings a combination of professionals with clinical, coding, reimbursement, data analytic, statistical, and information technology expertise to support health care providers and their counsel in regulatory compliance and government enforcement matters.  We have assisted academic medical centers, health systems, ambulatory surgery centers and other outpatient treatment and diagnostic facilities, as well as pharmacies, long term care facilities, home health, hospice and DME providers and their legal counsel.  Our experts have testified in court and negotiated settlements with government enforcement agents. Our services include:

  • False Claims Act, Anti-Kickback Statute, and Stark Law compliance support
  • Clinical documentation and billing compliance
  • Evaluation of medical necessity and levels of care
  • Clinical research compliance and investigations
  • Comprehensive corporate compliance program assessments and implementation
  • Compliance program monitoring and auditing work plan development and outsourcing
  • Post-settlement compliance with Corporate Integrity and Deferred Prosecution Agreements
  • Contract compliance assessments
  • Data privacy and security assessments and remediation
  • Quality of care reviews
  • Provider education on clinical documentation and coding
  • Compliance analyses in support of transactional due diligence 

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