Healthcare Compliance & Litigation Support

PYA offers a robust portfolio of regulatory compliance and investigative services. With a wide range of compliance expertise and industry experience, our team works alongside external counsel, organizational leadership, and front-line staff to mitigate and manage risk.  Regardless of your healthcare setting, PYA brings value with practical insights, innovative problem-solving, and radical responsiveness.

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 & Investigations

Fraud and Forensic Accounting Advisory
Kickback and Stark Law Violations
Financial Mismanagement
Government Investigations
Expert Witness Services

Telehealth and Virtual Services 

Program Development and Operations
Regulatory Updates
Documentation and Coding Reviews

Independent Monitorships

Independent Review Organization
Corporate Integrity Agreements

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.

Responsiveness

PYA has a reputation among clients for responsiveness. PYA's goal is to respond to calls and emails within 24 hours when possible.

PYA-Regulatory-Compliance-Financial-Industry-Healthcare-Consultants

Contact Our Healthcare Compliance & Litigation Support Team

Team Leaders

Lori Foley

Managing Principal of Revenue & Compliance Advisory and Office Managing Principal, Atlanta

David McMillan

Managing Principal of Consulting and Firm Chief Financial Officer

Subject Matter Experts

Sarah Bowman

Principal

Nina Eiler

Principal, General Counsel, and Director of Litigation Support

Barry Mathis

Managing Principal of IT Advisory Consulting

Valerie Rock

Principal

Jessica Scouten

Director of Forensic Services and Senior Manager

Shannon Sumner

Principal, Firm Chief Compliance Officer, Office Managing Principal, Nashville