Government Healthcare Consulting

Strengthening oversight and accountability in public healthcare funding and policy

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Help healthcare resources reach the people who need them

Healthcare is one of the most complex regulatory and funding environments in government. Every day, health-related agencies — and the service providers they support — confront evolving federal rules, shifting policies, and public demands for efficiency and accountability. And the stakes are exceptionally high: The communities they serve deserve quality healthcare and public health support.  

BDO has a long history of helping federally funded agencies and providers successfully operate in a highly regulated environment, balancing healthcare policy, resource allocation, compliance, and accountability. We have decades of experience with Medicare, Medicaid, SNAP, TANF, and other national healthcare programs, and we have worked extensively with state, county, and city governments to design and implement healthcare policies. We are familiar with the varying ways that different states support healthcare delivery in their communities. 

We are committed to improving the integrity, efficiency, and effectiveness of government-administered healthcare programs, helping governments better serve their citizens and elevate the availability and quality of care.  

How BDO Can Help

BDO offers government healthcare consulting services to help your organization achieve its goals.

  • Navigate Evolving Policies

    We help state governments and providers stay informed about shifting regulations and policies in the heavily regulated healthcare industry.

  • Maintain Accountability

    We have the experience and resources to support rigorous fiscal accountability, even for large national programs like Medicare and Medicaid.

  • Monitor Compliance

    We help states monitor MCOs, PBMs, and healthcare agencies for contract and regulatory compliance, accurate reporting, and independent auditing.

  • Manage Programs

    We help design and operate healthcare programs, determine eligibility, process applications, direct resources, and measure outcomes.

  • Navigate Evolving Policies

    We help state governments and providers stay informed about shifting regulations and policies in the heavily regulated healthcare industry.

  • Maintain Accountability

    We have the experience and resources to support rigorous fiscal accountability, even for large national programs like Medicare and Medicaid.

  • Monitor Compliance

    We help states monitor MCOs, PBMs, and healthcare agencies for contract and regulatory compliance, accurate reporting, and independent auditing.

  • Manage Programs

    We help design and operate healthcare programs, determine eligibility, process applications, direct resources, and measure outcomes.

Government Healthcare Capabilities

Our healthcare team has decades of familiarity with Medicare and Medicaid regulation and reimbursement, with continuous experience dating from the original launch of these programs. Our professional consultants include former CMS officials and state Medicaid directors, giving us unmatched insight into how policy translates to operational success. Our informed guidance assists state agencies in strengthening their operations, from policy development through program implementation.

Our Medicaid and Medicare services include the following: 
  • Medicaid policy 
  • Medicaid finance and inter-agency funding 
  • School-based Medicaid services 
  • Value-based care 
  • Cost reporting and reimbursement

We work with Health and Human Services (HHS) agencies at the state level to oversee federally funded programs and managed care organizations including SNAP, TANF, Medicaid, and more. Our experience with compliance and program management helps HHS groups navigate the complexities of federal funding and eligibility, while efficiently routing federal resources to local communities.  

Our HHS solutions include support for the following programs:  
  • Temporary Assistance for Needy Families (TANF) 
  • Supplemental Nutrition Assistance Program (SNAP) 
  • Women, Infants, and Children (WIC) 
  • Social Services Block Grant (SSBG)  
  • Community Services Block Grant (CSBG)

Public health challenges ranging from infant and maternal mortality rates to behavioral health and infectious disease response require organized, coordinated responses that are both compliant and effective. We help state health departments and human services agencies design, implement, and monitor these programs to help achieve meaningful results. Learn more about our disaster recovery services for public health emergencies.

Our work supports the following public health initiatives: 
  • Ryan White HIV/AIDS Program 
  • Housing Opportunities for Persons with AIDS (HOPWA) 
  • 340B Drug Pricing Program 
  • Public Health Emergency Preparedness (PHEP) Program 
  • Substance Use Prevention and Treatment Block Grant (SABG)

Responsibility for overseeing diverse Managed Care Organizations (MCOs) increasingly falls to state agencies, which may be underfunded and unprepared for the task. Our team has extensive experience in MCO oversight functions. We help state governments achieve accurate reporting and contract compliance, coordinate activities to maintain quality of care, and deliver resources and services to appropriate providers and beneficiaries.  

Our MCO services include:  
  • External Quality Review Organization (EQRO) services 
  • Audits conducted in accordance with government auditing standards 
  • Agreed-upon procedure reports and engagements in accordance with specified guidance 
  • Claims review and auditing 
  • Compliance and regulatory oversight

Pharmacy benefit managers (PBMs) play a critical role in how states manage prescription drug programs, but they also represent significant regulatory risk. We assist states in conducting PBM compliance audits, supporting adherence to state licensing requirements and performance standards. Our PBM oversight teams include licensed pharmacists and attorneys, combining clinical knowledge with regulatory and contractual experience to help states assess compliance and strengthen accountability. 

Our PBM services include:  
  • Retrospective audits 
  • Near-real-time monitoring 
  • Regulatory compliance 
  • Procurement

Rural communities face unique healthcare challenges — and new opportunities. BDO is currently helping states access and implement funding from the $50 billion Rural Healthcare Transformation Fund, assisting with applications, compliance planning, and program oversight. This initiative has the potential to reshape access to care across rural America, and we are proud to help make this ransformation a reality.

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Implementation and management for government programs are offered through BDO Government Services, LLC, a Delaware limited liability company and a separate legal entity affiliated with BDO USA, P.C.

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