Daylight Forensic & Advisory created a dedicated healthcare compliance practice to address the issues that are unique to healthcare litigation and compliance By far the most costly of these arise from regulatory or prosecutorial investigations for fraud and non-compliance issues.

• Since 2005, there has been increased emphasis on investigations to determine whether public funds meant for healthcare have been lost to fraud, waste, abuse, and poor quality of care. Scrutiny on all aspects of healthcare compliance has been intensifying in the past few years.
  
  
• These developments have precipitated new initiatives from Federal and State authorities to increase the recovery of of funds paid to providers that have violated administrative or criminal regulations.
  
  
• Many states (such as New York and California) are now armed with False Claims Acts (FCAs), modeled on the Federal FCA, that are designed specifically to increase recoveries and insure strict compliance. These acts contain both qui tam, or whistleblower provisions, and severe penalties for violations of the FCAs.

If an investigation is underway, Daylight’s multi-disciplinary healthcare team of former healthcare and Medicaid Fraud prosecutors, healthcare auditors, medical review experts, investigators, and statisticians can illuminate all facets of an investigation , help the client understand the methods used by agencies to arrive at their findings, and assist in devising means to contest these methods to mitigate financial exposure. Millions of dollars in penalties, fines, and restitutions can be assessed against a provider for healthcare compliance violations. However, agencies in either standard investigation or qui tam actions do not always use the most accepted auditing and extrapolation techniques, or they can be based on incomplete medical reviews, costing a provider millions of dollars that need not have been paid.

If the an investigation proceeds to litigation, data and evidence required for legal proceedings or internal investigations is often scattered among irrelevant documents and records, such as e-mail, transaction ledgers, instant-messages and financial spreadsheets and stored in differing technological formats varying by location or the time the record was generated.

Daylight’s team of e-discovery experts have the technological and procedural experience to identify and preserve evidence and present it in a clear and concise manner using strict chain of custody procedures that ensure evidentiary integrity. Many of Daylight’s e-discovery reviews are conducted with the cooperation and supervision of internal and external legal counsel, who provide guidance on the breadth of the matter and help determine which records are germane and must be preserved or shared with opposing counsel.

• Expert guidance from experienced healthcare prosecutors through all phases of the investigative process, including insight into methods and procedures of the investigation and its expected direction.
  
  
• Electronic discovery and evidence preservation
  
  
• Assistance responding to agency subpoenas and demand letters, and conducting internal investigations
  
  
• Examination of all aspects of methods used by agencies to determine findings, including sampling and extrapolation methods, by statisticians specializing in healthcare
  
  
• Analysis by medical review specialists of all billing and documentation used to arrive at findings
  
  
• Analysis by auditors specializing in healthcare to review auditing methods used to arrive at findings