Healthcare Compliance & Litigation Support

Healthcare compliance and litigation matters often begin with uncertainty: a billing concern, payer inquiry, hotline report, repayment question, subpoena, or government investigation. What starts as one issue can quickly involve legal, financial, operational, and reputational risk, requiring a team that understands healthcare regulations, data, documentation, and the realities of day-to-day operations.

With a wide range of compliance expertise and healthcare industry experience, PYA works alongside external counsel, organizational leadership, compliance teams, and front-line staff to assess risk, investigate concerns, quantify potential exposure, and develop defensible paths forward. Our professionals bring practical insight to complex, time-sensitive matters involving coding, billing, reimbursement, internal investigations, forensic analysis, litigation support, and regulatory advisory needs.

Our Compliance and Litigation Support Services

Revenue Integrity

Documentation and Coding Audits
Medical Necessity Compliance
Hierarchical Condition Categories (HCC) Risk Assessments
Regulatory Updates/Coding Advisory Support
Charge Capture Audits

Government/Payer Audit Response

RAC, UPIC, and Commercial Audit Appeals
Medicare/OIG Self-disclosure Assistance
Statistical Analysis & Overpayment Calculation
Independent Review Organization (IRO) Services
Corporate Integrity Agreement (CIA) Support Services

Compliance/Internal Audit Programs

Program Development and Effectiveness Assessments
Program and Enterprise Risk Assessments
Staff, Management, and Governing Body Education and Training
Physician Contract Process and Documentation Assessments
Work Plan Development, Execution and Project Management
Fractional/Virtual Program Support
PYA Compliance Overwatch–Long-Term Comprehensive Protection Program

340B Compliance

HRSA Audit Response/Readiness Assessments
Contract Pharmacy Compliance Assessments
Policy and Procedure Development
Internal Auditing and Monitoring Work Plan Development

Litigation Support

Kickback and Stark Law Violations
Financial Mismanagement
Government Investigations
Expert Witness Services

Forensic Accounting & Investigations

Fraud and Forensic Accounting Advisory
Internal investigations
Asset tracing
Financial analysis
Expert testimony
Transaction due diligence
Financial fraud prevention

Telehealth and Virtual Services 

Program Development and Operations
Regulatory Updates
Documentation and Coding Reviews

Independent Monitorships

Independent Review Organization
Corporate Integrity Agreements

Healthcare Compliance, Litigation, and Regulatory Advisory Services

Healthcare Compliance and Litigation Support Services

Regulatory Compliance and Healthcare Risk Assessments

Healthcare organizations operate in an increasingly complex regulatory environment shaped by evolving reimbursement rules, documentation standards, and enforcement activity. PYA assists providers with compliance risk assessments, coding and documentation reviews, internal investigations, and regulatory advisory services designed to help organizations identify and address operational and compliance vulnerabilities.

Litigation Support, Forensic Analysis, and Dispute Advisory

Healthcare disputes and investigations often require detailed financial, operational, and reimbursement analysis. PYA provides litigation support, forensic accounting, damages analysis, expert witness support, and reimbursement-related advisory services tied to healthcare disputes, investigations, and legal proceedings.

Compliance Program Support and Corrective Action Planning

Effective compliance programs require ongoing monitoring, education, and structured response planning. PYA helps healthcare organizations strengthen compliance oversight through program assessments, policy evaluation, corrective action planning, repayment analysis, and operational guidance related to government inquiries and regulatory matters.

Healthcare Compliance & Litigation Support Frequently Asked Questions

What types of issues may require a coordinated healthcare compliance and litigation response?

Matters may begin with a billing concern, payer inquiry, hotline report, repayment question, subpoena, or government investigation. A single issue can involve legal, financial, operational, and reputational risk, as well as coding, billing, reimbursement, documentation, investigation, and regulatory considerations.

What support may be needed during a government or payer audit?

PYA’s services include RAC, UPIC, and commercial audit appeals; Medicare and OIG self-disclosure assistance; statistical analysis and overpayment calculation; Independent Review Organization services; and Corporate Integrity Agreement support. Revenue integrity work may also address documentation, coding, medical necessity, HCCs, regulatory updates, and charge capture.

What can a compliance program effectiveness assessment cover?

PYA’s compliance program services include program development and effectiveness assessments, program and enterprise risk assessments, education for staff, management, and governing bodies, physician contract process and documentation reviews, work plan development and execution, project management, and fractional or virtual program support.

When can forensic accounting be useful in a healthcare matter?

Forensic accounting may be useful when a healthcare organization is addressing allegations of fraud, financial irregularities, disputed transactions, or other questions requiring focused financial analysis. PYA’s services include internal investigations, asset tracing, financial analysis, expert testimony, transaction due diligence, and financial fraud prevention.

Which matters may call for healthcare litigation support or expert witness services?

Healthcare litigation support may be appropriate when a dispute or investigation depends on complex healthcare financial, operational, or regulatory issues. This can include alleged Stark Law or Anti-Kickback Statute violations, financial mismanagement, government investigations, or matters requiring expert analysis of reimbursement, coding, billing, or other healthcare-specific information.

The PYA Difference

Over our 40-year history, PYA has consistently delivered high-value advisory services to our national client base. Our team is deployed to develop custom plans using proven approaches and work plans.

Independence

Private ownership means we answer only to our clients, not to third-party investors, giving us the freedom to be thorough and thoughtful in our work. We judge our success by our clients’ success.

Relationships

We value long-term relationships and work hard to maintain them. Our commitment to client relationships and the communities we serve remains constant.