CG Moneta Consulting

Forensic audit platforms for healthcare providers.

Specialized forensic audit platforms designed to help healthcare providers identify underpayments, revenue leakage, PBM opacity, and recoverable financial value across healthcare operations.

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ADHC Forensic review for underpayments, payer variance, and reimbursement contract compliance.

RCM Revenue cycle leakage, coding gaps, denials, compliance risk, and payer reimbursement reviewed.

PBM Contract performance, overpayments, missed rebates, specialty drug spend, and fiduciary oversight assessed.

Executive healthcare financial review presentation in a boardroom setting

Forensic Intelligence

Designed for finance leaders who require evidence, recovery, and control.

Enterprise Positioning

Forensic audit is not a report. It is a financial control mechanism for complex healthcare organizations.

Identify reimbursement variance hidden inside ordinary reporting.
Evaluate payer, PBM, and revenue cycle performance against financial expectations.
Prioritize recovery opportunities by evidence strength and materiality.
Translate findings into operating controls leadership can act on.

A broad platform for finding value that ordinary reporting misses.

CG Moneta’s forensic audit platforms help healthcare providers, employers, plan sponsors, funds, trusts, and pharmacies identify financial leakage, validate contract performance, improve compliance visibility, and convert complex reimbursement or benefit data into actionable recovery strategies.

Built on forensic reimbursement analysis, payer contract intelligence, and operational performance review.

Data-led evidence

Claims, remittance, denial, billing, coding, pharmacy, rebate, and plan data are analyzed to identify patterns that standard dashboards often fail to isolate.

Contract-aware review

Findings are evaluated against payer terms, PBM contracts, reimbursement obligations, plan design, and operational process realities.

Recovery-focused execution

The work is oriented around financial impact: recovering underpaid value, reducing leakage, strengthening controls, and improving future performance.

Executive meeting room with financial analytics presentation

Audit analytics and recovery modeling

Broad Overview

Where the platform fits in the healthcare financial enterprise.

The forensic audit portfolio is structured around three distinct financial pressure points: provider underpayment recovery, revenue cycle integrity, and pharmacy benefit cost oversight. Together, they clarify where revenue is lost, where spend is obscured, and where leadership can act.

Provider reimbursement

Identify payer underpayments, incorrect denials, suspended claims, and variance between expected and actual reimbursement.

Revenue cycle integrity

Review the full revenue cycle from charge capture and coding to denial activity, collections, reimbursement, and compliance risk.

PBM accountability

Evaluate prescription benefit performance, contract terms, overpayments, missed rebates, specialty drug costs, and fiduciary exposure.

Specific Platforms

Three separate services.
One executive standard.

Each audit platform addresses a distinct operational and financial performance challenge while maintaining a common forensic standard: evidence-led analysis, contract-aware review, reimbursement intelligence, recovery prioritization, and executive-ready findings that support financial oversight and operational accountability.

Platform 01

ADHC Underpayments

Go to ADHC audit website

Reimbursement analytics and audit review documents

Purpose

Designed to recover missed provider revenue by reviewing historical remittance activity, identifying payer underpayments, and assessing reimbursement variance against contractual obligations.

What is reviewed

Remittance and reimbursement activity going 2–5 years back, with payer contract experts and forensic audit software assessing contractual compliance and payer variance.

Financial focus

Underpaid claims, suspended claims, incorrectly denied claims, reimbursement variance, payer contract compliance, and recoverable provider revenue.

Executive outcome

A structured recovery strategy to help leadership quantify the opportunity, pursue payer recovery, and strengthen reimbursement controls.

Platform 02

Elevate Medical Revenue Cycle Forensic Audit

Go to Elevate audit page

Executive healthcare revenue cycle and operational performance review meeting

Purpose

A comprehensive forensic review of the healthcare revenue cycle, built to uncover leakage, billing errors, coding gaps, denial patterns, payer underpayments, inefficiencies, and compliance risk.

What is reviewed

Charge capture, coding, billing, payer reimbursement, denials, documentation, collections, workflows, compliance exposure, and overall revenue cycle performance.

Financial focus

Reduced denials, stronger collections, improved coding accuracy, workflow optimization, better reimbursement performance, and revenue improvement opportunities.

Executive outcome

An executive-ready audit report with findings, financial impact modeling, and recommendations to strengthen long-term revenue integrity.

Platform 03

PBM Forensic Audit

Go to PBM audit page

Pharmacy professional reviewing prescription and benefit documentation

Purpose

Built for self-insured employers, plan sponsors, funds, trusts, healthcare organizations, and independent pharmacies seeking transparency, recovery, and stronger PBM oversight.

What is reviewed

PBM contracts, plan design, pricing terms, rebate arrangements, overpayments, missed rebates, specialty drug costs, hidden fees, and contract inefficiencies.

Financial focus

Recovering pharmacy spend, validating PBM contract performance, increasing leverage in negotiations, and reducing exposure from opaque pharmacy benefit economics.

Executive outcome

Evidence to support PBM accountability, fiduciary oversight, compliance confidence, and long-term prescription benefit cost control.

Financial audit documents and performance reports under review

Financial impact and recoverable value

Financial Impact

The audit identifies the opportunity. Execution captures the value.

The goal is not merely to identify discrepancies. It is to show where value is being lost, prioritize what can be recovered, and strengthen the operating discipline that prevents future leakage.

Recovery

Quantify underpayments, PBM overcharges, missed rebates, denial-related leakage, and other recoverable value.

Control

Identify recurring process issues, contract interpretation gaps, vendor oversight weaknesses, and workflow inefficiencies.

Confidence

Provide executive-ready evidence that supports payer recovery, PBM accountability, revenue cycle improvement, and compliance oversight.

Why CGM

Enterprise advisory rigor with audit-level specificity.

Financial performance lens

Evaluation is framed around margin, cash flow, revenue integrity, cost control, compliance, and resilience.

Specialized platform expertise

Each audit has a distinct domain focus, from payer underpayments to RCM performance and PBM accountability.

Measurable findings

Findings are prioritized around materiality, recoverability, root cause, evidence strength, and operational pathway.

Actionable executive output

Leadership receives a clearer basis for recovery decisions, vendor discussions, remediation, and long-term controls.

Methodology

A structured path from data to recovery.

Scope

Define audit population, data sources, contracts, payer or PBM relationships, and review period.

Ingest

Collect claims, remittance, billing, denial, pharmacy, rebate, plan, and contract data where applicable.

Analyze

Apply contract logic, variance review, anomaly detection, and forensic analytics to isolate leakage.

Prioritize

Rank findings by financial materiality, recoverability, evidence strength, and operational pathway.

Act

Support recovery, remediation, payer or PBM accountability, and future control improvements.

Next Step

Find what current reporting is not showing you.

Begin with a focused forensic review to determine which audit platform best aligns with your reimbursement, revenue cycle, or pharmacy benefit challenge.

CG Moneta Consulting helps healthcare providers, employers, plan sponsors, and benefit stakeholders convert forensic audit findings into financial action.

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Forensic Audit Platforms

Forensic audit platforms for healthcare providers.