Healthcare & Government Enforcement

Healthcare and government enforcement matters turn on billing data and dollars, and we deliver the litigation consulting analysis that defines exposure, tests the government's theory, and surfaces what the claims record actually shows.

WHERE WE ADD WEIGHT

Enforcement matters where the record is the argument

01
Full Population
Analysis

02
Defensible
Methodology

03
Senior-Led
Delivery

EXPLORE OUR APPROACH

  • Statistical sampling & extrapolation

    Damages models in healthcare enforcement matters often rest on extrapolating from a sample of claims, which makes the case turn on whether the sample is representative and the method sound. Verdict Consulting Group rebuilds the claim population, tests and rebuts the sampling methodology, and models how the damages shift when the assumptions do.

  • Alleged overpayments & payment disputes

    A demand to claw back years of claims comes down to one question: What was actually owed, paid, and withheld? We reconstruct the claims, payments, and contract terms to establish the real picture behind the number, a core part of our government enforcement work.

  • Out-of-network & payer / provider disputes

    Payment and coverage disputes turn on what a claim should have paid and where adjudication broke down. Verdict Consulting Group runs usual-and-customary rate analysis, evaluates the claims-adjudication process, and reconstructs billing patterns across Medicare, Medicaid, and commercial payers.

  • Financial relationships (AKS / Stark)

    Where an investigation turns on whether physician compensation or referral arrangements tracked the volume or value of referrals, we map those relationships and referral patterns against the arrangements at issue, so counsel can see what the data supports in an Anti-Kickback or Stark enforcement matter.

  • RICO & enterprise analysis

    Where healthcare fraud allegations reach beyond a single actor, we map the enterprise structure, identify and quantify the alleged predicate acts, and run multi-defendant pattern analysis, the kind of enterprise-level government enforcement work Verdict Consulting Group is built for.

Capabilities built for the record.

  • False Claims Act and qui tam matters — testing relator allegations against the data, sizing exposure, and supporting both relators’ and defense counsel.

  • Government investigations and enforcement — large-scale data processing to respond to grand jury subpoenas and government inquiries.

  • Payor / provider payment disputes — reconstructing claims, payments, and contract terms to establish what was owed, paid, and withheld.

  • Class-action exposure analytics — sizing potential class damages and exposure across large claim and member populations.

  • Statistical sampling and extrapolation — design, evaluation, and critique of the methodologies that drive alleged damages.

  • Claims and billing data analytics across Medicare, Medicaid, and commercial datasets to isolate the population at issue and test allegations against the record.

  • Damages, overpayment, and penalty analysis, modeled across realistic scenarios.

  • Financial and transaction analysis to follow the money behind the conduct.

Whether you're defense counsel responding to a subpoena, relators' counsel evaluating a qui tam claim, or a payor or provider in a payment dispute, we bring the same senior-led, full-population analysis to every healthcare enforcement matter.

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