Risk Management in Healthcare: PwC

The health industry is facing a myriad of challenges

The health industry is facing enormous challenges and fundamental shifts in how it operates. Organizations are transforming how they leverage technology and manage digital capabilities in the wake of the pandemic. At the same time, they’re confronting increased reliance on third-party systems and service providers, cost pressures and an increasingly complex, evolving regulatory environment. And they’re doing all of this with heightened scrutiny from auditors, shareholders and government agencies. This broad array of challenges dramatically increases and complicates the financial, technological, compliance and regulatory risk faced by healthcare companies.

How PwC can help risk management in healthcare

At PwC, we address the complex problems and business transformations faced by our clients. The healthcare industry confronts new demands and risks daily, and our global team of more than 4,000 US and 12,000 global professionals is ready to meet the challenge these demands present.

The goal: moving from reactive — or compliance-driven — approaches to more proactive resilient growth strategies.

With cross-functional expertise, cutting-edge analytics and technology enablement solutions, PwC can help in developing healthcare controls, systems and processes, addressing key governance issues and can provide guidance on risk oversight.

Provider

Internal Audit

Leveraging leading practice internal audit methodology in areas such as risk assessment, audit plan development, audit execution and reporting along with Provider industry leading subject matter specialists we help you enable your organization to achieve strategic, financial, and operational objectives by being a "trusted advisor."

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Compliance Services

Leveraging industry subject matter specialists and leading practices, optimize compliance for your organization through regulatory response support, compliance office transformation and redesign assistance, managed services, deals due diligence, and compliance monitoring.

Eletronic Health Record (EHR) and Enterprise Resource Planning (ERP) Controls & Security

Utilizing our library of EHR and ERP controls, PwC specialists help design and operationalize controls to mitigate operational, financial and compliance risks.

340B

PwC’s technology and approach brings cost effective monitoring to your organization, helping you to mitigate 340B program compliance risks. PwC’s tech-enabled monitoring approach also satisfies the annual third-party audit expectation per HRSA guidelines.

Payer

Compliance & Regulatory

Helping organizations achieve operational excellence in their compliance activities through compliance program transformation, tech enablement (compliance and operational performance monitoring), and operations through managed services. We leverage industry subject matter specialists and leading practices to support compliance and regulatory activities such as appeals & grievances, utilization management, call center, care management, regulatory reporting (e.g., CMS) etc.

Contract Compliance

Serving as market leaders in providing PBM Rebate Assessments on behalf of Payers and other large Employer groups, we leverage analytics and automation to perform assessments to identify potential non-compliance related to rebate pass-through to our clients.

Financial controls

Supporting our clients through compliance with Model Audit Rule and other financial controls programs by providing a scalable delivery model with the support of technical specialists, leveraging automation and digital solutions to overall drive value, efficiency, and effectiveness.

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Internal Audit

Leveraging leading practice internal audit methodology in areas such as risk assessment, audit plan development, audit execution and reporting along with Payer industry leading subject matter specialists we help you enable your organization to achieve strategic, financial, and operational objectives by being a "trusted advisor."

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Pharmaceutical and Life Sciences

Compliance services

Build, transform, operate, and/or automate your compliance activities from risk assessment through executing on monitoring plans. Our leading class platform, Risk Detect, integrates and streamlines corporate compliance activities across the lifecycle. We also offer flexible solutions to bring expertise to operate compliance activities via cosourcing or outsourcing).

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HCP Interactions

Manage interactions with healthcare providers and healthcare organizations. Designed from real-world experience, PwC’s customizable system helps pharmaceutical and life sciences companies stay current and compliant.

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Transparency reporting

Simplify global transparency reporting with our holistic, cloud-based compliance solution. Our tools can connect to any system, aggregate data, and streamline compliance reporting globally.

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Internal Audit

Leveraging leading practice internal audit methodology in areas such as risk assessment, audit plan development, audit execution and reporting along with PLS industry leading subject matter specialists we help you enable your organization to achieve strategic, financial, and operational objectives by being a "trusted advisor."

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Regulatory

Bringing end-to-end Regulatory services to help companies navigate the complex regulatory environment and transform Regulatory functions to be a value creator. Our experienced advisors have developed and executed on effective strategies globally that resolve regulatory challenges, optimize and automate processes, and actively embed risk resilience in the DNA.

Contract Compliance & 340B Monitoring

Bringing the best of PwC’s regulatory, compliance, and technical expertise to deliver contract compliance and 340B program Integrity services through tech-enabled, data-driven assessments of wholesalers, pharmacy benefit managers (PBMs), specialty pharmacies, and patient assistance programs including “double/triple dip” analysis for manufacturers to curtail revenue leakage and drive increased margins.

Cyber Managed Services

Protect your business from evolving cyber threats with PwC's Cyber Managed Services. By entrusting your cyber defense functions to us, you can minimize risks, optimize operational costs, and stay ahead of changing threats and regulations. Our skilled workforce and flexible technology ensure effective identification and response to security data, events, and alerts.

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Higher Education

Internal Audit

Leveraging leading practice internal audit methodology in areas such as risk assessment, audit plan development, audit execution and reporting along with Higher Education industry leading subject matter specialists we help you enable your Institution to achieve strategic, financial, and operational objectives by being a "trusted advisor."

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Regulatory Compliance

Broad support of your regulatory compliance risk activities, from assessing program maturity, to evaluating the design and operating effectiveness of your internal controls. Including but not limited to risks related to Uniform Guidance compliance, Clinical Trials, HIPAA, and export controls.

Compliance Monitoring

Supporting regulatory compliance programs with expertise in financial controls, third party risk management, electronic medical records, sponsored research, development / fundraising, diversity and inclusion, auditing and benchmarking through co-source or outsourced models and critical applications.

Health Policy and Intelligence Institute

Practical insights on regulatory and policy developments in health industries

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Case studies

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