Our mission is to empower healthcare providers to protect their revenue, reputation, and regulatory standing by delivering expert guidance through every phase of Fraud, Waste, and Abuse (FWA) audit engagement. We are committed to providing rigorous audit validation, strategic response planning, and hands-on education that enable our clients to navigate complex compliance challenges with confidence. Our mission is to empower healthcare providers to protect their revenue, reputation, and regulatory standing by delivering expert guidance through every phase of Fraud, Waste, and Abuse (FWA) audit engagement. We are committed to providing rigorous audit validation, strategic response planning, and hands-on education that enable our clients to navigate complex compliance challenges with confidence. Through advocacy, precision, and proactive risk management, we help organizations build a culture of integrity and resilience in an ever-evolving regulatory landscape.
What We Offer
Dual Perspective Expertise We bridge the enforcement-provider gap with unmatched experience on both sides of the regulatory aisle—local, state, and federal law enforcement, and payer-side program integrity insight with deep knowledge of clinical operations and healthcare administration.
End-to-End Post-Audit Advocacy Unlike firms that focus solely on compliance training or pre-audit prep, we specialize in navigating the most critical and high-stakes phase: audit findings, response strategies, and settlement negotiations. Our clients aren’t just prepared—they’re protected.
Tailored Corrective Action Coaching We don’t hand over cookie-cutter CAP templates—we work with each provider to design realistic, achievable, and defensible action plans that preserve operational integrity while satisfying regulatory obligations.
Provider Empowerment Through Education We prioritize education that builds internal confidence: helping providers understand their rights, strategically negotiate outcomes, and internalize compliance as a core competency—not just a checkbox.
Services We Provide
FWA Audit Readiness Consulting Services
Our consulting service is a specialized solution designed to help healthcare providers proactively prepare for audits related to Fraud, Waste, and Abuse (FWA) compliance. The service provides end-to-end support, equipping organizations with the tools, knowledge, and practices necessary to meet regulatory standards and minimize financial and reputational risk.
Key Service Components:
- Pre-Audit Risk Assessment We begin by conducting a comprehensive evaluation of the provider’s internal compliance environment, billing practices, and documentation protocols. This assessment identifies key areas of vulnerability to FWA exposure, ensuring remediation efforts are prioritized effectively.
- Policy and Procedure Review Our experts meticulously review existing compliance policies and operational procedures, benchmarking them against current CMS regulations and industry best practices. We provide actionable recommendations and updates to ensure full alignment with legal expectations.
- Staff Training and Education We deliver tailored training programs to all relevant staff—administrative, clinical, and billing—on recognizing, preventing, and reporting FWA activities. Our education modules not only increase compliance awareness but also foster a culture of accountability.
- Documentation and Data Validation Support We assist in reviewing clinical documentation and claims data to validate accuracy, integrity, and consistency. This step helps reduce the risk of improper payments and strengthens readiness for any external audit inquiries.
- Mock Audit and Gap Analysis Simulated audit exercises are conducted to stress-test the provider’s preparedness. Our consultants then deliver a detailed gap analysis report with targeted corrective actions and best practices for continuous improvement.
- Ongoing Compliance Monitoring Framework For long-term sustainability, we help build internal controls and monitoring systems tailored to the provider’s operations. These frameworks support ongoing compliance and early identification of potential FWA issues.
Value Proposition:
By partnering with us, healthcare providers gain more than just audit preparation—they secure a strategic shield against costly financial setbacks. Our consulting service is engineered to minimize the risk of retrospective denials and retractions of previously paid claims, a common consequence of FWA audit findings. Through rigorous documentation validation, staff education, and proactive policy refinement, we help ensure billing accuracy and compliance integrity across all operational levels.
Provider return on investment is twofold:
- Revenue Protection – Providers avoid significant claw backs, financial penalties, and reimbursement demands by identifying vulnerabilities and addressing them before payors or regulators do.
- Operational Efficiency – With stronger internal controls and streamlined processes, organizations reduce waste, decrease rework due to claim errors, and lower the likelihood of audit-triggering anomalies.
Ultimately, our service empowers healthcare providers to move from a reactive to a proactive compliance posture—preserving revenue, protecting reputation, and fostering long-term sustainability in an increasingly regulated healthcare landscape.
Post-Audit Support & Resolution Services for FWA Audit Findings
Our Post-Audit Support & Resolution service is a comprehensive solution designed for healthcare providers navigating the complex landscape of Fraud, Waste, and Abuse (FWA) audit findings. This offering is tailored to address the critical post-audit phase, where accurate interpretation of audit results, strategic response development, and settlement negotiation can significantly impact a provider’s financial and operational outcomes.
Key Service Components:
- Audit Results Validation and Dispute Assessment Our team performs a meticulous review of audit reports and underlying claim data to assess the validity of FWA determinations. We cross-analyze documentation, coding, and regulatory criteria to identify errors, inconsistencies, or overreaches in the audit conclusions, arming providers with defensible positions for appeal or dispute.
- Strategic Audit Response Support We assist in drafting compelling and evidence-based responses to audit notices, including rebuttal narratives, supporting documentation compilation, and regulatory references. Providers receive customized guidance on timelines, formatting, and submission standards to ensure compliance and maximize the likelihood of a favorable outcome.
- Corrective Action Plan (CAP) Design and Negotiation Coaching We help healthcare entities craft meaningful, achievable CAPs that demonstrate compliance improvement without admitting wrongdoing. Our experts also educate providers on negotiation tactics—how to maintain leverage, communicate intent, and avoid overly burdensome requirements that could disrupt care delivery or operations.
- Settlement Review and Advocacy Should financial recoupments be proposed, we guide providers through the settlement process. This includes reviewing proposed amounts, determining the viability of counteroffers, and providing strategic recommendations on partial settlements or payment structuring to reduce financial strain.
- Provider Education & Empowerment Through one-on-one sessions or team workshops, we educate leadership and compliance teams on the rights and remedies available during post-audit proceedings. Our training helps demystify complex legal language, reinforce internal advocacy strategies, and position providers for future audit resilience.
Value Proposition:
Our service ensures that healthcare providers are not left vulnerable in the aftermath of an FWA audit. By delivering specialized validation, advocacy, and negotiation support, we help protect hard-earned revenue, reduce exposure to unjust settlements, and enhance provider readiness for future regulatory engagement. The result is greater financial stability, empowered compliance leadership, and a stronger defense against enforcement overreach in an increasingly scrutinized environment.
Ongoing Quality Assurance Review Services for Medical Records and Claims
Our Quality Assurance (QA) Review service offers healthcare organizations a structured, continuous, and independent evaluation of clinical documentation and claims submitted to payers. This ongoing monitoring solution is designed to promote compliant documentation, accurate billing, and reduced denial rates—fostering both regulatory adherence and operational efficiency.
Key Service Components:
- Routine Medical Record Audit We conduct periodic, statistically valid sampling of medical records across multiple service lines. Each chart undergoes detailed evaluation for completeness, clarity, and compliance with payer documentation requirements, including medical necessity, signature standards, and timeliness.
- Claims Review and Reconciliation Our team cross-references reviewed records with submitted claims to identify variances in coding, modifiers, diagnosis linkage, and service bundling. This reduces improper claim submission and proactively addresses risk areas for payer audits or denials.
- Error Categorization and Risk Scoring Identified issues are classified by severity—ranging from clerical errors to potential FWA concerns—and assigned risk scores. This enables organizations to track trends over time and prioritize corrective actions based on both financial impact and compliance exposure.
- Feedback and Provider Education We provide detailed audit reports paired with targeted education for clinical and billing staff. These include examples of compliant versus non-compliant documentation, feedback sessions, and coding refresher training to reinforce best practices.
- Customized Reporting Dashboards Clients receive access to a secure portal with real-time analytics, key performance indicators (KPIs), trending compliance scores, and benchmarking against industry standards. Reports are segmented by department, provider, and error type to aid data-driven decision-making.
- Regulatory Alignment Our QA framework is regularly updated to reflect evolving payer policies, CPT/ICD updates, CMS guidelines, and federal regulations—ensuring reviews remain relevant, accurate, and defensible.
Value Proposition:
By embedding QA reviews into routine operations, healthcare organizations gain a powerful compliance buffer that prevents revenue leakage, lowers denial rates, and enhances documentation quality before claims ever leave the door. Beyond risk mitigation, our program cultivates a culture of continuous improvement and accountability—strengthening both payer relationships and internal coding competency. The result is a more compliant, resilient revenue cycle and a workforce equipped to meet the demands of a dynamic healthcare landscape.