Healthcare
In healthcare, the relationships among hospitals, health plan operators, clinics, laboratories and suppliers involve fee schedules, claim denials, price adjustments and service agreements with significant financial impact.
Industry context
Disputes arise over billed and denied amounts, contractual price adjustments, the termination of provider agreements, and corporate transactions between providers. Technical evidence in this sector requires understanding its particular billing practices.
SGEx acts in this environment as a technical firm, engaged when the industry produces disputes, inquiries, reviews, losses, buyout claims, fraud, rendering-of-accounts matters or valuations that call for an independent examination.
Questions that arise in this industry
- Calculation of amounts billed, denied and paid.
- Review of price adjustments and compensation clauses.
- Quantification of losses arising from contract and provider-agreement terminations.
- Expert assistance in accounting and economic expert examinations.
- Valuation in corporate transactions between providers.
How SGEx Approaches This
SGEx may examine: sGEx typically reviews contracts and fee schedules, billing and denial reports, payment statements, financial statements and documentation of care-related costs.
Every engagement begins by framing the technical question, continues with the organization of these sources, and ends with conclusions presented in the format the proceeding requires, with assumptions and limitations disclosed.
Possible Work and Deliverables
The format is defined according to the case, the proceeding and the purpose of the work.
- Technical expert questions
- Party-appointed expert's opinion
- Critical review of a report
- Submissions and requests for clarification
- Calculations and technical statements
- Court-appointed accounting expert report
Other SGEx Solutions
Services, specialties, contexts and industries connected to this topic under SGEx's relationship matrix.
Related Services
- Accounting Expert ExaminationIndependent expert examination of accounting records, financial statements and calculations, prepared for judicial, arbitral and administrative proceedings.
- Economic and Financial Expert AnalysisAnalysis of values, cash flows, economic assumptions and financial models in disputes and decisions that turn on quantification.
- Disputes, Litigation and ControversiesEconomic, financial and accounting expert support in judicial, arbitral, administrative and pre-litigation controversies.
- ArbitrationTechnical analysis, quantification and expert assistance in arbitral proceedings involving economic, financial and accounting issues.
- Court Calculations and Accounting SupportPreparation, review and challenge of court calculations for law firms, companies and organisations, with validation technology and high-volume production.
Related Areas of Practice
- Civil and Contract DisputesNonperformance, termination, contract revision and civil liability claims in which the controversy turns on monetary values and calculations.
- Corporate and Shareholder DisputesDisputes among shareholders, partners and officers, corporate dissolutions, buyout claims and disagreements over financial results.
- Administrative and Regulatory MattersAdministrative proceedings and regulatory disputes with an economic and financial impact on companies and concession holders.
Related Industries
- Insurance and ReinsuranceClaims, loss adjustment, reinsurance treaties and disputes among insurers, policyholders and reinsurers.
- Construction, Engineering and InfrastructureConstruction works, engineering projects and infrastructure assets subject to cost, schedule and rebalancing claims.
- Cryptocurrency and Digital AssetsCustody, movement and recordkeeping of crypto-assets in investigations, disputes and asset-tracing engagements.
Request an Analysis
Describe the technical question, the context in which it arose, and the documents available. This information lets SGEx assess the scope of the work before any proposal.