Your partner in Healthcare Compliance
Healthcare Regulatory & Compliance Advisory for Medicaid, CHIP, and Marketplace Health Plans
Our Approach
Operator-led advisory for healthcare organizations navigating regulatory scrutiny, audit exposure, and execution risk across Medicaid and Marketplace environments.
Led by a healthcare compliance operator with direct experience in audit readiness, regulatory operations, and delegated oversight across Medicaid and Marketplace environments.
What This Looks Like in Practice
Supported health plan through regulatory audit readiness
Strengthened delegated entity oversight across multiple vendors
Identified and mitigated compliance risk exposure pre-audit
Where This Breaks in the Real World
Delegated UM that breaks under audit scrutiny
Appeals that fail under volume and timelines
Vendor oversight that exists—but isn’t provable
Documentation that doesn’t match what actually happened
What We Do
We help healthcare organizations operate with clarity and control in high-accountability environments.
Identify regulatory and operational risk before it becomes exposure
Prepare for CMS, state, and contractual audits with defensible execution
Strengthen delegated and vendor oversight structures
Translate complex requirements into operational decisions that hold up under scrutiny
How This Works
Identify Risk
Targeted assessment of compliance posture, audit readiness, and operational gaps.
Stabilize Exposure
Direct support during audits, regulatory reviews, and high-risk periods.
Maintain Control
Ongoing advisory to guide decisions, reduce exposure, and strengthen execution.
Typical Engagements
Risk Assessment
2 - 3 Weeks.
Audit Support
Aligned to Audit Timeline.
Advisory Retainer
Ongoing monthly support.
Where Compliance Breaks Down
Most organizations understand the rules. The breakdown happens in execution—especially when requirements change faster than operations can keep up.
Delegated vendors operating without real oversight
Documentation that fails to reflect operational reality
Audit readiness that exists on paper but fails under scrutiny
Gaps between regulatory requirements and day-to-day execution
Leadership forced into reactive decision-making during audits
Regulatory and contractual changes already in effect but not operationalized—creating immediate exposure
WHO WE WORK WITH
Medicaid, CHIP, and Marketplace health plans
Delegated vendors and specialty service providers operating under plan oversight
Select provider organizations and FQHCs with complex regulatory and operational exposure
We also stay closely connected to trade associations and broader industry stakeholders across Texas.
When to Engage
Upcoming CMS, state, or contractual audit
Recent audit findings or corrective action plans
New product or line of business launch
Concerns around delegated or vendor oversight
Internal uncertainty around compliance execution
New regulatory or contractual requirements that have not been operationalized
Every audit tells a story. The only question is whether you control it.
Start a Conversation
Most clients engage us when something already feels off. The earlier we get involved, the more options you have.