Expert Forensic Accountants Serve Healthcare Practices, Partnerships, LLCs, and Corporations

Knowledgeable advice to establish the value of practices and quantify liability

The U.S. population is aging, increasing the demand on government programs, such as Medicare and Medicaid, while providers receive ever decreasing reimbursements. A changing regulatory environment and a combination of health crises in the general population, such as COVID-19, opioid addiction, obesity, and mental health has further stressed the healthcare system. Meanwhile, providers who strive to deliver high quality care must constantly guard against litigation. We can also identify risk in areas related to fraud and ventures involving other healthcare providers. Finally, we can provide robust litigation support in insurance disputes and malpractice claims.

Litigation support for malpractice claims and insurance disputes

According to Johns Hopkins University research, medical errors are the third leading cause of death in the United States. Many more patients are harmed by substandard care and must sue to obtain compensation for personal injuries. For plaintiffs’ attorneys, NAFA calculates economic damages, which include projections of future medical expenses, lost income, and other continuing harm.

On the other hand, healthcare providers are often targeted in spurious litigation, because they are seen as deep-pocketed defendants. Patients who are disappointed in their health outcomes can resort to malpractice lawsuits, which draw practitioners into conflicts with insurance companies, whether their own or a third party’s. These disputes are potentially devastating, especially for small practices. Fortunately, NAFA supports defendants with damage calculations that can protect conscientious healthcare providers from exorbitant demands.

On either side of the conflict, our forensic experts can appear in court as expert witnesses to support the financial aspects of the case.

Business valuations and quality of earnings reports for healthcare providers

As with any business, a healthcare provider might look to expand operations or penetrate a related market through the acquisition of an asset, or through a merger or joint venture. Professional corporations or partnerships might acquire a private practice from a provider who is retiring or who will onboard as a new partner. Under such circumstances, parties on both sides of the proposed transactions need to know the value of the business.

NAFA performs in-depth analyses of various business assets in the healthcare industry. Our experts in business valuation scrutinize records to determine how much the enterprise in question is worth. In our quality of earnings reports, we go beyond the simple question of revenue to determine the likelihood that revenue will continue in the future. For medical practices, this includes an examination of patient retention, patient demographics, trends in the volume of patients, and trends within the community being served.

Post-acquisition disputes in healthcare

The purchase price of a healthcare asset is often contingent of revenue realized in the proceeding months or years. When reality doesn’t match estimates, at least one side of the transaction is going to be disappointed. That disappointment can erupt into a legal dispute when the two sides cannot agree on the total of reported revenue. NAFA can often nip such disputes in the bud by performing forensic analysis of business records for the disputed periods. Our trustworthy assessments often speed settlements, saving both parties time, money, and frustration.

Detecting fraud in the healthcare industry

In the healthcare industry, fraud is a multibillion-dollar-a-year problem. Fraud in your medical practice can destroy your reputation and expose you to extreme sanctions that include hefty fines and prison. Healthcare practitioners and their employees may engage in these types of fraud:

  • Skimming of receipts
  • Payroll schemes
  • Expense schemes
  • Kickbacks for referrals
  • Insurance, Medicare, and Medicaid fraud
  • Performing medically unnecessary services
  • Double billing for the same service
  • Phantom billing for services never performed
  • Upcoding, so patients are charged for a more expensive service than the one provided
  • Unbundling, so that services meant to be billed together at a discounted price are billed separately for a higher price
  • Diverting legal prescriptions for illegal use
  • Forging prescriptions

On the other hand, healthcare providers and their patients can be the victims of fraud. Hackers and identity thieves can use health insurance information to commit insurance fraud.

NAFA is comprised of certified experts in fraud detection. We can find the source of illegal activity and produce the evidence you need to pursue the appropriate remedies.

Thorough assessment of damages for business interruptions

NAFA is ready to assist with lost profit and business interruption claims for clients in the healthcare industry. There are myriad reasons a healthcare provider can suffer business interruption losses, such as a fire at a facility, flood damage, power outages, forced pandemic shutdowns, and cyber-attacks. When the cause of the business interruption is an insurable event, you are entitled to recover under your business interruption insurance. But how much are you entitled to? And how can you prove your losses?

NAFA excels at calculating business interruption losses for businesses with complex, incomplete or disorderly record keeping. We understand the healthcare industry and the copious red tape tying up revenue. We conduct thorough examinations to assess lost profits as well as the cost of physical damage to facilities and equipment.

Additionally, like any business, a healthcare provider can sustain losses due to theft of trade secrets, proprietary information, or other intellectual property. NAFA can help account for losses due to these kinds of business torts.

In all types of civil litigation, our NAFA team can appear as expert witnesses to provide concise and cogent testimony on the financial aspects of the case.

Contact NAFA for healthcare forensic accounting services

North American Forensic Accounting provides a range of advanced accounting services to medical practices, partnerships, hospitals, nursing homes and other providers throughout the United States. NAFA serves clients from offices throughout the United States, including in Philadelphia, Pittsburgh, New York City, Atlanta, Charlotte, Miami, and the Tampa Bay Area. Call us at 347-286-4860 or contact one of our offices online to schedule an appointment.