Department of Justice Litigative Consultant

StrategicHealthSolutions, LLC (Strategic) serves as the litigative consultant for contracts with the U.S. Department of Justice (DOJ) and Office of Inspector General (OIG). As the litigative consultant, Strategic provides coding and medical review expertise in support of DOJ and OIG investigations, in addition to statistical sampling methodologies, error rate identification, and overpayment calculations. Strategic’s responsibilities also include providing expert testimony by deposition or in court.

The Litigative Consultant Services team — which consists of professionals with many years of experience in medical review, coding, and statistical work — has a highly successful partnership with the DOJ and OIG, two of Strategic’s customers. It is a top-performing team that meets and exceeds the customers’ expectations through the following:

  • Excellent project management skills
  • Exceptional analytical and review skills
  • Expert knowledge of Medicare and Medicaid regulations, policies, and coverage guidelines
  • Achievement of accreditations, certifications, and credentials, including
    • Registered Nurse
    • Doctor of Medicine
    • Certified Professional Coder
    • Registered Health Information Administrator
  • Expert knowledge of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes and Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Categories
  • Achievement of an Inter-Rater Reliability (IRR) score of more than 95 percent for medical review and coding work. IRR is a measure of reliability used to assess the degree to which different reviewers agree in their assessment decisions.

The team is also successful because its professionals focus on a common goal: providing the customer with quality work, an objective that positions Strategic as the “go to contractor” for medical review work in the Federal marketplace.