Transforming Data Integrity and Audit Capabilities for a Major U.S. Healthcare Provider

When a leading U.S. healthcare provider approached us, they were facing a challenge that’s all too common in large, complex organizations: no single source of truth for business‑critical data. Their ERP systems were disconnected, data lived in silos, and the absence of integrated analytics meant they lacked the ability to perform meaningful audit and fraud analysis.

The stakes were high—without unified, reliable data, operational efficiency, compliance, and risk management were all at risk.

The Challenge

• Multiple ERP systems operating in isolation

• No consolidated view of key business entities

• Limited ability to detect fraud or conduct in‑depth audits

• Inefficient processes for managing recalls, contracts, and compliance claims

Our Solution

We designed and implemented a comprehensive systems and data integration strategy that not only solved the immediate pain points but also laid the foundation for long‑term operational resilience. Key initiatives included:

• Product Recall Management System – Streamlined recall tracking and resolution.

• PCARD Fraud Analysis Tool – Enabled proactive detection and investigation of fraudulent activity.

• GPO Contracts Data Integration – Centralized contract data for improved compliance and negotiation leverage.

To sustain these capabilities, we established and led a dedicated Audit Analytics department, responsible for supporting audit and fraud analysis across the organization. This included acquiring and processing data from multiple client ERP systems daily to ensure audits were timely, accurate, and actionable.

Innovation in Compliance Auditing

We also designed new claim types tailored to healthcare contract compliance audits, including:

• Pharmaceutical 340B drug pricing claims

• Medical device warranty claims

These innovations expanded the provider’s ability to recover funds, enforce compliance, and protect revenue streams.

Building Internal Capability

Beyond technology, we invested in people. We mentored new employees in:

• Recovery audit processes

• ERP systems and data acquisition

• ETL workflows and audit data processing

• Specialized recovery audit tools

This knowledge transfer ensured the organization could maintain and evolve its audit capabilities independently.

Collaboration for Ongoing Success

Our work didn’t stop at implementation. We partnered closely with the Sales and Operations Management teams to:

• Oversee current audit projects

• Prepare Risk Analyses for potential new clients

• Deliver post‑audit narratives and disbursement analysis reports

This day‑to‑day collaboration ensured that the provider’s audit function became a strategic asset—delivering both compliance assurance and measurable financial returns.

Outcome  

By unifying data, enabling advanced analytics, and building internal expertise, we transformed the provider’s audit and compliance capabilities from reactive to proactive—empowering them to protect revenue, reduce risk, and operate with confidence.