Fraud Investigation & Forensic Accounting

Internal Investigation – Anti-Kickback Statute

Our professionals led the forensic accounting investigation of a complex network of physicians to identify the structure and timing of allegedly improper referrals and kickbacks. Analyzed the business and personal financial records of subjects to create a comprehensive timeline illustrating the financial organization illicit network. While this investigation originally involved two physicians, our investigators identified a complex network of over 35 physician groups, and three additional kickback networks. forensic accountant richmond

Medical Device Manufacturer Investigation

Managed the forensic accounting investigation of a Fortune 100 medical device manufacturer regarding improper payments and gratuities provided to physicians, hospitals, and teaching institutions in contradiction with the PhRMA code. Identified specific improper payments disguised as charitable sponsorships, honoraria, and R&D equipment.

Internal Investigation – Hostile Management Takeover

Retained as a testifying expert on behalf of an $80 million Managed Services Organization (MSO) to conduct an internal investigation following the company’s hostile management takeover. Analyzed financial records related to various Accountable Care Organizations (ACOs), healthcare IT partnerships, and joint ventures. Identified and quantified several business arrangements potentially subject to Stark and Anti-Kickback regulations. forensic accountant richmond

Training Program – Investigative Interview Techniques

Interviews represent the most basic and human element of any investigation. Diligent interviewers constantly search for a complete and truthful telling of events. This course highlights the best practices of interviewing techniques and provides a variety of considerations and tools for your next interview. Our team has provided this training to multiple audiences including internal auditors and government investigators.

Post-M&A Investigation

Retained as a testifying expert on behalf a $100 million pharmacy services company to conduct an internal investigation related to the company’s acquisition. Analyzed financial records related to payer obligations for federal, state, and 3rd party payments.   Quantified in excess of $50 million of financial damages due to improper billing and accounting practices.

Healthcare Fraud Investigation

Led multiple fraud investigations of provider practices to assess, identify, and quantify issues of improper billing code manipulation. Issues included cases of billing for unnecessary procedures, billing for procedures never performed, “unbundling” of billing codes, and inflation of bills by “up coding”. Worked closely with Department of Health and Human Services (HHS) and counsel to analyze and synthesize billing data for a variety of clinical providers. forensic accountant richmond

False Claims Act – Government Forensic Accounting

Our professionals led the forensic accounting investigation of whistleblower allegations at a Fortune 100 device manufacturer. Allegations included inflation of costs on over $650M of cost-plus contracts for the U.S. Government, and improper application of government Cost Accounting Standards (CAS) in accordance with the Federal Acquisition Regulation (FAR). Reviewed over five years of cost disclosure documentation and worked closely with the DCAA to assess the materiality of issues identified. Identified multiple process weaknesses and worked closely with the client to remediate deficiencies resulting in no financial sanctions against the company.

Internal Investigation – Revenue Recognition

Conducted an investigation in response to a formal SEC inquiry on behalf of a Fortune 100 energy parts manufacturer. Addressed the treatment of in-transit products and the timing of revenue recognition. The investigation resulted in a $128MM restatement of earnings.