Ripped from the Headlines: When Boards Fail in Their Oversight Role
SunHawk Consulting, LLC is excited to announce that Managing Director, Martin Biegelman will be presenting at the SCCE 22nd Annual Compliance and Ethics Institute. Don't miss out on Martin's presentation "Ripped from the Headlines: When Boards Fail in Their Oversight...
Martin Biegelman on Conflicts of Interest
SunHawk Consulting, LLC is excited to announce that Managing Director, Martin Biegelman will be presenting at the SCCE Basic Compliance & Ethics Academy on September 14, 2023 in Boston, MA. Don't miss out on Martin's presentation on CONFLICTS OF INTEREST. The...
Auditing Controls versus Transactions – A Case Study
SunHawk Consulting, LLC is excited to announce that Managing Director, James Rose will be presenting at the 2023 September Auditing & Monitoring Conference on September 6, 2023 The presentation will be a case study on AUDITING CONTROLS VERSUS TRANSACTIONS You Will...
Fraud and Collaboration with Clinical and Medical Coding Teams
SunHawk Consulting, LLC is excited to announce that Lorraine Aniello and Leah Lane will be presenting on the topic of "A Healthcare Study in Fraud and Collaboration with Clinical and Medical Coding Teams" at the Clinical Practice Compliance Conference, which is being...
“RISK” in Risk Adjustment
In our previous article, we explained how Risk Adjustment is a “partnership” between the patient, the provider, the insurance plan (Plan), and the governmental entity. So, which partner in this process holds the “risk”? Governmental Entity: The governmental entity has...
Risk Adjustment Is a Partnership???
Under the risk adjustment (RA) model, reimbursements to the insurance companies (Plans) are based on the member’s level of severity of illness rather than the number and types of interventions the member receives throughout the year. This reimbursement model is based...
Martin Biegelman on Conflicts of Interest
SunHawk Consulting, LLC is excited to announce that Managing Director, Martin Biegelman will be presenting at the SCCE Basic Compliance & Ethics Academy on June 8, 2023 in San Diego, CA. Don't miss out on Martin's presentation on CONFLICTS OF INTEREST. The...
Leah Lane on “Assessing your Anti-Fraud Program” and “Investigation Guidelines: A Practical Tool for Investigators”
We are excited to announce that Director, Leah Lane will be presenting at the ACFE Global Fraud Conference in Seattle, WA. Leah will be doing a pre-conference session on Sunday June 11th on Assessing your Anti-Fraud Program. On June 12th she will be presenting...
Are You Ready For The 2024 Risk Adjustment Model?
This article, as part of the SunHawk Consulting team’s Medical Risk Adjustment compliance as well as statistical sampling & coding audit services, gives a high level overview of some upcoming changes for 2024 in the CMS Risk Adjustment model, V28. The CMS-HCC Risk...
Developing an Audit Engagement Scope and Approach – Audit Skills 2.0
Interested in advancing your audit skills and developing an audit engagement scope? SunHawk Managing Director James Rose, along with Sara E. Coverstone, Chief Compliance & Privacy Officer, Northern Arizona Healthcare, are presenting later this month at HCCA...
Corporate Integrity Agreements (CIAs) and How to Mitigate Burgeoning Risks – by Nancy Roht
As the Department of Health and Human Services' (HHS) Office of Inspector General (OIG) continues to ramp up its enforcement efforts, SunHawk Consulting had prepared a summary report to help organizations stay informed of the latest trends in Corporate Integrity...
Top 5 Considerations for Your NetSmart Avatar Implementation – by James Rose
The NetSmart myAvatar platform provides a modern physical and behavioral health electronic health (EHR) record solution. As with all EHR implementations, there is a lot to consider before upgrading your environment, including how much of the heavy lift of the...
Conflicts of Interest: Martin Biegelman Presenting at the SCCE Basic Compliance & Ethics Academy
We are pleased to announce that our Managing Director, Martin Biegelman, will be presenting next month at SCCE Basic Compliance & Ethics Academy in Nashville, TN on the topic of Conflicts of Interest. Highlights Conflicts of interest are some of the most...
Evaluation of Compliance Programs: How to get the most out of your confidential hotline
The February 2023 issue of the SCCE Compliance and Ethics Professional (CEP) Magazine is featuring one of our Directors, Scott Moritz, with an article on How to get the most out of your confidential hotline. Preview the article below and click HERE to read the full...
Corporate Integrity Agreement Summary Report January Update
The United States Government requires Corporate Integrity Agreements (CIA) for health care Providers, Payers and Life Science companies when settling allegations of false claims related to quality of care or corporate integrity issues, against various Federal health...
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2550 E Rose Garden Ln.
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SunHawk Consulting specializes in professional consulting services and has a team of highly skilled subject matter experts with substantial backgrounds in:
* Healthcare Compliance: Statistical Sampling, Medical Coding Audits, Healthcare Compliance Programs, Evaluation of Compliance Programs and Risk Assessments, HIPAA Compliance Risk Assessments & Training, Corporate Integrity Agreement (CIA) Board Advisor, Independent Review Organization (IRO) Services, Interim Healthcare Compliance Support, Physical Security Assessment, Design and Implementation of Sunshine Act Compliance Programs, Enterprise Risk Management Optimization, Governance, Risk and Compliance (GRC) System Support, Electronic Health Record (EHR) System Implementation, Outsourced Audit Function Support, Medical Risk Adjustment Compliance (Medicare, Medicaid, Commercial), Policy, Procedure, Internal Control Development and Evaluation, FedRAMP Compliance;
* Corporate Investigations: Fraud Investigations and Forensic Accounting, Anti-money Laundering (AML), Bank Secrecy Act (BSA), Know Your Customer (KYC), Foreign Corrupt Practices Act, Third-party Due Diligence;
* Corporate Compliance: Evaluation and Design of Corporate Compliance Programs, Interim Compliance Support, Compliance Risk Assessments, Physical Security Assessment, Enterprise Risk Management, Private Equity Governance, GRC System Support, Audit Function Support, Fraud Risk Assessments, Investigations Program Assessment and Enhancements, Qui Tam Investigations, Hot Line Support;
* Litigation Disputes: Complex Litigation and Disputes, Mergers and Acquisitions: Regulatory Due Diligence, Expert Witness, Statistical Analysis, Healthcare Payment Disputes, Litigation Support, Physical Security Assessment, Neutral Party Data Analysis.