COMPLIANCE

For businesses in the health care industry, strong compliance programs are critical to meeting customer and regulator expectations. Demonstrated commitment to compliance can even be a major selling point. Bradford, Perlstein has worked with multiple clients to assess, implement, operate and improve compliance programs. We also provide risk assessment and risk mitigation services, and have significant experience in addressing HIPAA requirements and issues, and in conducting internal investigations. John Perlstein leads the firm’s efforts in this area. As both a former Chief Compliance Officer for CIGNA Corporation and Chief Counsel for CIGNA HealthCare, John brings significant technical and practical experience to bear, and has a clear understanding of how compliance efforts can enhance the effectiveness and efficiency of business operations.

 

We offer ongoing support for the operation of a compliance program, including mentoring or providing assistance to a lawyer or other compliance professional you may bring in to manage day-to-day compliance operations.  In addition, we offer as-needed support to address any specific compliance issues that may arise.

Support for Compliance Program Operation
  • Affordable Care Act (“Obamacare”), including Medical Loss Ratio, essential health benefits, small business and individual coverage rules

  • HIPAA Security and Privacy requirements and issues

  • Medicare and Medicaid contracting and reimbursement

  • Health insurance, utilization review and third party administrator licensing 

  • Claim payment, appeals and overpayment recovery rules

Regulatory compliance
  • Compliance program assessment

  • Compliance program development, implementation, and enhancement

  • Assistance with assessment and management of internal issues

  • Compliance staff mentoring and development

  • Compliance with contractual obligations

  • Federal and state regulatory compliance

 

General Corporate Compliance Services

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