A compliance-program operating system for value-based care — built around risk assessment, continuous monitoring, audits, investigations, and corrective action. Come see it in Orlando.
We don't claim to be your full compliance program — your governance, training, and disciplinary processes are yours. What we do: operationalize the two elements where claims data actually drives the work, and produce defensible evidence artifacts for the others.
| OIG Element | Pamastay support |
|---|---|
| Core Capabilities · Elements 6 & 7 | |
| 6Risk Assessment, Auditing, and Monitoring | Core capability. Claims-based risk scoring, RADV risk targeting, continuous monitoring across CCLF and EDI feeds, configurable outlier library with MUE, orphan DME, and HCC-gap detection. Direct |
| 7Responding to Detected Offenses and Developing Corrective Action Initiatives | Core capability. Investigation workflow, case management, audit-ready export packages with full detection lineage, corrective-action tracking, and verification records — closing the loop on every finding. Direct |
| Supporting Artifacts · Elements 1–5 | |
| 1Written Policies and Procedures | Evidence artifacts — detection-logic documentation, threshold configurations, and versioned rule sets your policies can reference. Artifact |
| 2Compliance Leadership and Oversight | Board-ready dashboards and executive reporting packages for the CCO and compliance committee. Artifact |
| 3Training and Education | Complementary to your training program. We surface which clinicians show coding or billing variance, so your training is targeted where it matters. Artifact |
| 4Effective Lines of Communication with the Compliance Officer and Disclosure Program | Outside our scope — your compliance hotline and disclosure program are separate governance infrastructure. We contribute audit-trail artifacts for documenting what was reported, investigated, and closed. Artifact |
| 5Enforcing Standards: Consequences and Incentives | Provider scorecards, peer benchmarks, and trend data that back up disciplinary and incentive decisions — grounded in comparable data, not subjective judgment. Artifact |
Short demos, no pitch deck. Pick the one that fits your program.
See how RADV risk scoring identifies which HCCs and providers are most likely to be sampled — and which may have the most documentation risk. Perfect for MA plans and ACOs.
One-click export of detection logic, findings history, and corrective-action tracking. The artifact we'd hand to an OIG auditor for Element 7 on your behalf.
A 10-minute look at the CMS, OIG, and state DMHC actions our enforcement tracker is monitoring right now — and how we'd flag the patterns in your claims feed.
Prefer email? Reach us at hello@pamastay.com.
Our public enforcement feed is a live mirror of CA DMHC actions and federal OIG resources — so you can see what regulators are focused on this quarter.
We'll bring the demo to you. A 30-minute video walk-through, your claims scenarios, our OIG-aligned workflow.