Leading Healthcare Compliance, Auditing & Telehealth Infrastructure Solutions
We specialize in protecting healthcare providers and revenue cycle management professionals from false claims liability through comprehensive compliance auditing, HIPAA-encrypted telehealth platforms, and complete practice infrastructure solutions. Our mission is to ensure regulatory adherence while empowering medical professionals with cutting-edge technology and expert guidance.
Your Trusted Partner in Healthcare Compliance & Regulatory Excellence
State False Claims Auditors (SFCA) is a premier healthcare compliance organization dedicated to safeguarding medical practices, billing companies, and healthcare professionals from the substantial risks associated with false claims violations under federal and state law. With deep expertise in the False Claims Act (FCA), HIPAA regulations, and telehealth compliance requirements, we provide comprehensive solutions that ensure your practice remains compliant, protected, and financially optimized.
Our organization recognizes that healthcare fraud enforcement continues to intensify, with the Department of Health and Human Services recovering billions annually through False Claims Act settlements. In this complex regulatory environment, healthcare providers face unprecedented scrutiny from government agencies, insurance payers, and regulatory bodies. SFCA bridges the critical gap between clinical excellence and regulatory compliance, offering turnkey solutions that address every aspect of modern healthcare delivery.
We serve medical professionals across all specialties, dental practices, revenue cycle management contractors, billing companies, telehealth providers, and healthcare organizations of all sizes. Our integrated approach combines compliance auditing, technology infrastructure, training programs, and ongoing support to create sustainable, regulation-compliant healthcare operations.
Specialized knowledge in Federal False Claims Act, State FCA laws, HIPAA, HITECH, and healthcare fraud prevention regulations
Enterprise-grade encrypted cloud platforms with business associate agreements, audit trails, and comprehensive data protection
Proven track record serving healthcare providers nationwide with customized compliance programs and technology solutions
Comprehensive training programs covering clinical documentation, telehealth delivery, billing compliance, and regulatory requirements
SFCA provides comprehensive compliance and infrastructure solutions designed specifically for healthcare professionals and revenue cycle management contractors. Our services ensure regulatory adherence, operational efficiency, and protection against false claims liability while leveraging modern technology to enhance patient care delivery.
Complete Practice Infrastructure & Compliance for Physicians, Dentists & Healthcare Providers
Our comprehensive solution for medical professionals provides everything needed to establish and maintain a fully compliant, technology-enabled practice. From HIPAA-encrypted electronic medical records to federal enrollment administration and specialty care management, we deliver a complete practice-in-a-box that meets all regulatory requirements while positioning your practice for success in value-based care models and telehealth delivery.
Enterprise-grade electronic medical records system with end-to-end encryption, secure data storage, automated backups, role-based access controls, and comprehensive audit logging. Fully compliant with HIPAA Security Rule technical safeguards and includes business associate agreements with all vendors. Cloud-based architecture ensures accessibility from any location while maintaining data integrity and patient privacy.
Complete administration of Medicare, Medicaid, and commercial payer enrollment processes including PECOS registration, National Provider Identifier (NPI) management, CAQH credentialing, state medical board licensing coordination, and institutional network participation processing. We handle all documentation, follow-up, and maintenance requirements to ensure uninterrupted reimbursement eligibility and regulatory compliance.
HIPAA-compliant secure messaging tunnel enabling encrypted communication between providers, staff, and patients. Includes secure remote interface access for telehealth consultations, patient portal functionality with identity verification procedures, encrypted file transmission capabilities, and multi-factor authentication protocols. All communications maintain end-to-end encryption and comprehensive audit trails for compliance documentation.
Strategic processing and management of hospital medical staff applications, ambulatory surgery center privileges, imaging center affiliations, and specialty network participation. Includes credentialing documentation preparation, peer reference coordination, malpractice certificate management, and ongoing privileging maintenance to maximize practice revenue opportunities and patient access across multiple care settings.
Advanced telemetry interface supporting wireless medical devices including blood pressure monitors, glucose meters, pulse oximeters, weight scales, and cardiac monitors. Real-time data transmission to EMR with automated alerts for out-of-range values, customizable clinical protocols, and automated time tracking for CPT code 99454, 99457, and 99458 reimbursement. Enables proactive chronic disease management and reduces hospital readmissions.
Specialized workflow modules for chronic care management (CCM), principal care management (PCM), behavioral health integration, and complex chronic care management. Includes patient assessment templates, care plan documentation tools, medication reconciliation systems, and automated time tracking for accurate billing compliance. Supports value-based care initiatives and enhances patient outcomes through structured care coordination.
Comprehensive business and clinical training covering telehealth service delivery fundamentals, virtual consultation best practices, HIPAA privacy protocols for remote care, reimbursement requirements, state licensure compliance, consent documentation, and technology platform utilization. Includes training on audio-visual telehealth, store-and-forward asynchronous services, and remote patient monitoring program implementation.
Integrated patient engagement platform providing secure access to medical records, appointment scheduling, prescription refill requests, and direct messaging with care team. Includes patient assessment questionnaires with clinical decision support, automated appointment reminders, patient education materials library, and telehealth video consultation interface. Enhances patient satisfaction while reducing administrative burden and improving care coordination efficiency.
Specialized telehealth training programs across multiple clinical specialties including cardiology, endocrinology, psychiatry, dermatology, orthopedics, and primary care. Each program addresses specialty-specific clinical protocols, equipment requirements, documentation standards, liability considerations, and reimbursement optimization. Includes certification upon completion and ongoing continuing education access to maintain expertise as telehealth regulations and technologies evolve.
Comprehensive Infrastructure for Independent RCM Contractors & Billing Companies
Designed specifically for independent revenue cycle management professionals and billing companies, our RCM solution provides the complete technology infrastructure, compliance support, and business development tools needed to successfully serve healthcare provider clients. From API connectivity to major payers to inbuilt billing tools and client management systems, we empower RCM contractors to deliver exceptional service while maintaining full regulatory compliance and operational efficiency.
Foundational compliance infrastructure including HIPAA policies and procedures, business associate agreement templates, security risk assessment tools, breach response protocols, workforce training materials, and compliance monitoring documentation. Includes all necessary forms, checklists, and operational procedures to establish and maintain a compliant revenue cycle management operation that meets federal and state regulatory requirements.
Direct API integration with major insurance payers including Medicare, Medicaid, Blue Cross Blue Shield networks, UnitedHealthcare, Aetna, Cigna, and other commercial carriers. Enables real-time eligibility verification, electronic claim submission, remittance processing, claim status inquiries, and automated denial management. Reduces claim processing time, minimizes manual data entry errors, and accelerates reimbursement cycles for improved cash flow management.
Comprehensive support for healthcare provider credentialing and enrollment across institutional networks, insurance panels, and facility medical staffs. Includes application preparation, documentation management, follow-up coordination, and ongoing maintenance of credentialing databases. Ensures provider clients maintain continuous participation status across all revenue-generating opportunities while meeting complex payer-specific requirements and timelines.
Professional-grade revenue cycle management software platform featuring charge capture, claim scrubbing, electronic claim submission, payment posting, denial management, accounts receivable tracking, and comprehensive reporting dashboards. Includes ICD-10 and CPT code libraries with annual updates, compliance edits, aging analysis tools, and customizable key performance indicator tracking. Multi-client architecture allows independent billers to efficiently manage multiple provider accounts from a single platform.
Strategic business development support for independent RCM contractors including client acquisition strategies, service pricing models, contract templates, client onboarding procedures, and practice marketing guidance. Includes client relationship management (CRM) system with automated communication workflows, performance reporting tools, and client retention strategies. Consultation covers business entity formation, liability insurance requirements, and growth strategies for scaling revenue cycle management operations.
Dedicated OIG Compliance Program Auditing for Small & Mid-Size Medical and Dental Clinics
Our annual compliance audit contract services provide small and mid-size medical and dental clinics with comprehensive, ongoing compliance support tailored to meet Office of Inspector General (OIG) General Compliance Program Guidance standards. We deliver expert HIPAA breach risk assessments, compliance plan development and implementation, regulatory audit preparation, and detailed compliance program documentation to protect your practice from enforcement actions, civil monetary penalties, and false claims liability.
Comprehensive compliance program development following the seven core elements mandated by OIG General Compliance Program Guidance (November 2023): written policies and procedures, compliance officer designation and oversight structure, targeted training and education programs, effective communication channels and disclosure mechanisms, enforcement standards with consequences and incentives, systematic risk assessment and auditing protocols, and breach response procedures. Each compliance plan is customized to your practice's specialty, size, and specific risk profile, ensuring alignment with federal Anti-Kickback Statute, Stark Law, False Claims Act, HIPAA regulations, and applicable state healthcare laws.
Annual comprehensive HIPAA Security Rule and Privacy Rule assessments examining administrative, physical, and technical safeguards across your entire practice operations. Includes systematic security risk analysis identifying vulnerabilities in electronic protected health information (ePHI) systems, physical security controls evaluation, workforce training compliance verification, business associate agreement reviews, breach notification readiness assessment, and incident response plan testing. Detailed audit reports document compliance status against all 120+ HIPAA safeguards with prioritized remediation recommendations to address identified gaps before regulatory enforcement or patient data breaches occur.
Specialized audits examining billing patterns, clinical documentation quality, coding accuracy (CPT, ICD-10, HCPCS), medical necessity justification, and claims submission practices to identify potential False Claims Act violations before government investigation. Comprehensive review of Medicare and Medicaid billing compliance, evaluation and management (E/M) service documentation, modifier usage accuracy, unbundling and upcoding risk assessment, duplicate billing detection, and Stark Law self-referral compliance verification. Proactive identification of compliance vulnerabilities enables corrective action implementation before OIG enforcement or whistleblower qui tam litigation exposure.
Expert preparation services for HHS Office for Civil Rights (OCR) HIPAA audits, CMS Medicare audits, OIG investigations, Recovery Audit Contractor (RAC) reviews, and commercial payer audits. Includes pre-audit document organization, policy and procedure gap analysis, mock audit simulations, staff interview preparation coaching, and onsite audit support representation. We ensure your practice maintains audit-ready compliance documentation including up-to-date policies, training records, risk assessments, business associate agreements, breach logs, and corrective action tracking systems that demonstrate good-faith compliance efforts and may qualify for penalty reductions under civil monetary penalties law provisions.
Annual compliance training programs delivered to all workforce members covering HIPAA privacy and security requirements, false claims prevention, fraud and abuse regulations, proper documentation practices, coding and billing compliance, conflict of interest policies, and incident reporting obligations. Role-specific training modules for physicians, billing staff, clinical personnel, and administrative teams address job-specific compliance risks and responsibilities. Training documentation includes attendance records, comprehension assessments, and annual certification to satisfy OIG compliance program education requirements and demonstrate due diligence in enforcement proceedings.
Continuous compliance monitoring throughout the annual contract period with quarterly compliance assessments, regulatory update alerts for new healthcare laws and guidance, policy revision assistance responding to regulatory changes, compliance hotline access for staff questions and concerns, and monthly compliance performance metrics reporting. Proactive advisory services keep your practice informed of emerging compliance risks, enforcement trends, new OIG guidance publications, OCR audit focus areas, and industry best practices. Regular communication ensures compliance program effectiveness and enables rapid response to identified compliance issues before they escalate into violations.
SFCA offers comprehensive, all-inclusive packages designed to provide maximum value while ensuring complete regulatory compliance and operational excellence. Our pricing structure is transparent, with no hidden fees, and includes all essential components for successful healthcare practice operations or revenue cycle management services.
Comprehensive Compliance & Technical Infrastructure for Physicians, Dentists & Healthcare Providers
Secure Payment Options Available
Complete Technical Infrastructure for Independent Revenue Cycle Management Professionals & Billing Companies
Secure Payment Options Available
Dedicated OIG Compliance Auditing for Small & Mid-Size Medical and Dental Clinics
Secure Payment Options Available
Package Benefits: All packages include dedicated compliance officer support, regulatory update notifications, comprehensive documentation and reporting, secure cloud-based compliance portal access, and priority technical assistance. Multi-year contracts available with additional discounts. Custom enterprise solutions available for large healthcare organizations and multi-location practices.
Payment Terms: Annual subscriptions billed at contract signing. Quarterly payment plans available for annual audit contract services. All major payment processors accepted including industry-compliant secure payment platforms. Automatic renewal available for convenience. No setup fees or hidden charges. 30-day satisfaction guarantee on all services.
Ready to protect your practice with comprehensive compliance solutions and cutting-edge healthcare technology? Contact State False Claims Auditors to schedule a consultation and learn how our services can transform your healthcare operations while ensuring complete regulatory compliance.