What does healthcare revenue integrity include?

Documentation and coding audits, medical necessity compliance, HCC risk assessments, regulatory updates and coding advisory support, and charge capture audits.

What is covered under government and payer audit response?

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 services.

What belongs in a compliance and internal audit program for healthcare organizations?

Program development and effectiveness assessments, program and enterprise risk assessments, education and training for staff, management, and the governing body, physician contract process and documentation assessments, work plan development and execution with project management, and fractional or virtual program support, including Compliance Overwatch.

What does 340B compliance and readiness involve?

HRSA audit response and readiness assessments, contract pharmacy compliance assessments, policy and procedure development, and internal auditing and monitoring work plan development.

Which litigation support services help during investigations and disputes?

Support for kickback and Stark Law violations, financial mismanagement reviews, response to government investigations, and expert witness services.

What do forensic accounting and investigations provide in compliance matters?

Internal investigations, asset tracing, financial analysis, expert testimony, transaction due diligence, and financial fraud prevention.

How do HCC risk assessments support accurate risk adjustment and compliance?

They evaluate documentation and coding related to hierarchical condition categories as part of revenue integrity activities.

What is medical necessity compliance in day-to-day operations?

Reviews that assess whether documentation supports services billed, within revenue integrity and audit activities.

What is included in telehealth and virtual services compliance support?

Program development and operations, regulatory updates, and documentation and coding reviews for virtual care.

What are independent monitorships in healthcare compliance?

Independent Review Organization activities and Corporate Integrity Agreement monitoring that help organizations demonstrate ongoing compliance.

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

PYA Healthcare Pediatrics Compliance Experts

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.

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.