The old way
Billions in recoupments. Facilities closed. Careers ended. Stars destroyed. Taxpayers still paying for charts that were never right — because nobody read across every EMR before the money moved.
Patent-protected AI — PDPM Audit Optimization Group
Fight fraud at the chart. Defend the building.
A solution to combat healthcare fraud — without burning down the house.
As enforcement intensifies, regulators and operators face the same question: shut down whole facilities, or fix the documentation that false claims depend on? PDPM Audit Group and RevOptix1 use patent-protected artificial intelligence to read skilled nursing charts the way OIG, RAC, UPIC, and state surveyors do — exposing what is not supported, defending what is, and giving legitimate SNFs a path to compliance before the clawback letter arrives.
455 charged in $6.5B DOJ takedown — KUTV, 6/24/2026. Start audit defense now or explore the PDPM & MDS scoring tool.
PDPM & MDS scoring · live preview
PDPM outputs
MDS 3.0 profile
Primary clinical category
Acute Neurologic
PT groupTO
NTA4 · NF
BIMS13
NursingES3
2026 National Health Care Fraud Takedown
DOJ charged 455 people in $6.5B alleged fraud. Your charts are in the queue.
Per KUTV (June 24, 2026), the Department of Justice charged 455 defendants across 45 states in alleged healthcare fraud schemes involving more than $6.5 billion in false Medicare and Medicaid claims. OIG, UPIC, and state MFCUs are cross-referencing the same documentation SNFs bill on every day.
RevOptix1 reads your charts the way auditors do — and gives you the defense before they ask. Our patent-protected solution → · Subscribe now →
Source: KUTV — “455 people charged in alleged $6.5B healthcare fraud schemes,” 6/24/2026
Real news · trimmed to key moments
Four actual news clips on 2026 healthcare fraud charges
Embedded footage from FOX 9 and YouTube — each clip trimmed to the timestamps you selected. Press play for the full montage (~1 min 26 sec).
Real 2026 healthcare fraud news — press play.
4 clips · ~1 min 26 sec · Ends on CA hospice at 0:20
Sources (embedded — not re-hosted)
- FOX 9 — Fraud crackdown: 455 recently charged in healthcare fraud cases (6/23/2026) · clip 0:05–0:20
- YouTube — Florida healthcare fraud takedown: 9 indicted in massive Medicare scam · clip 1:08–1:45
- YouTube — Dr. Oz on billion-dollar healthcare fraud scandal · clip 0:00–0:14
- YouTube — Alleged hospice fraud in California · clip 0:00–0:20
Free download
SNF Audit Survival Kit
PDPM audit risk checklist, ICD-10 documentation red flags, and 10 failures OIG looks for in SNF claims — free for administrators, DONs, and compliance leaders.
- 25+ interactive PDPM audit risk checks
- 15 ICD-10 documentation red flags
- 10 OIG failure patterns with self-audit tips
Patent-protected · AI-powered
Get the word out: there is a better way to fight fraud.
Stop false claims at the source. Keep legitimate skilled nursing facilities standing.
The largest healthcare fraud crackdowns in history are here. Everyone agrees fraud must end. The fight is over how. Scorched-earth enforcement closes buildings, displaces residents, and still misses the documentation errors that started the problem. PDPM Audit Group at pdpmauditgroup.com, powered by RevOptix1™, is a patent-protected AI platform built for precision: verify the chart before you verify the dollar.
The PDPM Audit Group way
AI cross-references physician notes, nursing notes, MDS, and procedure history across every EMR. False claims surface early. Legitimate revenue is recovered with audit-ready proof. Facilities fix gaps privately — without burning down the house to prove a point.
For SNF leaders
See your charts the way auditors see them before they arrive. Confidential mock surveys, state-specific survey checklists, and PDPM defense — so you coach your team instead of explaining failures to a U.S. Attorney.
For enforcement & integrity
When the question is “was this claim supported by documentation?” our engine answers it at line-item level across fragmented EMRs — the same fragmentation fraud hides behind and good facilities struggle to reconcile.
For taxpayers & payers
Stop paying for care that was never documented. Stop destroying providers that could have corrected errors with the right mirror held up to their charts. Precision beats punishment.
Zero fraud opportunity
RevOptix1 cannot invent codes or fabricate revenue. It only surfaces what is already in the record — structurally incapable of upcoding, built to defend every dollar with source documentation.
Patent-protected technology. RevOptix1™ and PDPM Audit Optimization Group combine registered intellectual property with audit methodology aligned to OIG, RAC, TPE, UPIC, CERT, MFCU, and state survey protocols. Questions or partnership requests: audit-defense@pdpmauditgroup.com.
State survey readiness
Walk into your state survey knowing your score — before surveyors assign one.
State survey results do not stay inside the building. They shape your CMS star rating, hospital referral patterns, Medicaid rate conversations, and every auditor who opens your file next. Our State-Specific Mock Survey mirrors the checklist your state health department actually uses — licensing rules, federal F-tags, MDS focus areas, infection control, and Medicaid audit fields — so administrators, DONs, and compliance leaders see exactly where they stand while there is still time to act.
Built for your state, not a template
Each mock survey uses that state's DHHS requirements — Utah R432 and IPC tools, Alabama 420-5-10 and Medicaid cost-report fields, and the CMS Appendix PP survey tags every state surveyor applies. More states added continuously.
Prioritized gap report leaders can use
Every line item is scored with plain-language notes your team can act on Monday morning. High-risk deficiencies surface first — the ones that become immediate jeopardy, civil money penalties, or referral-killing star drops on a real survey.
Confidential, coachable, defensible
Delivered only to you. Train the IDT, brief ownership, or close gaps quietly — without creating a discoverable event that triggers the very scrutiny you are preparing for.
Documentation + survey readiness together
Pair the mock survey with RevOptix1 chart review. The MDS and care-plan gaps surveyors cite are the same documentation gaps that leak PDPM revenue. Close them once; defend twice.
Step 1
Select your state checklist — structured on the fields state surveyors and Medicaid auditors review.
Step 2
Walk your facility systems with our guided audit — nursing, infection control, environment, MDS, and admin.
Step 3
Receive a readiness summary ranked by survey risk — with a clear path to fix before the entrance conference.
How we work together
PDPM Audit Group + RevOptix1 — platform and experts, same engine.
You don’t have to choose between self-serve software and expert audit defense. We built both around the same cross-EMR methodology — so you can subscribe today and escalate to hands-on support when the audit letter arrives.
Self-serve subscription
RevOptix1™ Platform
Upload charts, run unlimited audits, get audit-defended ICD-10 recovery reports. Monthly compliance reviews and quarterly staff training included. Start in minutes — no sales call.
Subscribe at revoptix1.comExpert-led engagements
PDPM Audit Optimization Group
Confidential chart review, state-specific mock surveys, and live audit defense when OIG, RAC, UPIC, or state surveyors are already reviewing your facility. Same RevOptix1 engine, human expertise.
Request expert engagementPDPM Audit Group pricing
Choose your focus. Same bed-count tiers as RevOptix1.
Every skilled nursing facility has a different compliance pressure point. Pick the lane you need most — MDS accuracy, state survey readiness, or federal audit defense — and we price it the same way RevOptix1 does: by certified bed count. Expert-led engagements include the RevOptix1 engine plus human audit defense from PDPM Audit Optimization Group.
Focus track 1
MDS & PDPM documentation
For facilities where case-mix, RAI accuracy, and physician–nursing–MDS alignment are the priority. Platform-led with expert MDS oversight.
Starting at
$3,500 / month
Under 75 beds · same tiers as RevOptix1
- Under 75 beds$3,500/mo
- 76–150 beds$5,000/mo
- 151–200 beds$8,000/mo
- 201+ beds$12,000/mo
- RevOptix1 platform + unlimited chart review
- MDS 3.0 & PDPM case-mix scoring
- Monthly MDS compliance review
- Quarterly MDS coordinator training
- Audit-defended ICD-10 recovery reports
Focus track 2 · most popular
State survey readiness
For administrators preparing for Department of Health surveys, Medicaid FCP reviews, and state-specific licensing audits. Includes our interactive state mock survey checklists.
Starting at
$5,500 / month
Under 75 beds · expert-led mock surveys
- Under 75 beds$5,500/mo
- 76–150 beds$7,500/mo
- 151–200 beds$11,000/mo
- 201+ beds$16,000/mo
- Everything in MDS focus
- State-specific mock survey (Utah, Alabama + expanding)
- DHHS / licensing checklist walkthrough
- CMS Appendix PP F-tag gap analysis
- Quarterly on-site or virtual survey prep session
Focus track 3
Federal audit defense
For facilities facing or preparing for OIG, RAC, UPIC, TPE, CERT, and MFCU reviews. Highest-stakes documentation defense with live audit response support.
Starting at
$8,000 / month
Under 75 beds · includes live response
- Under 75 beds$8,000/mo
- 76–150 beds$11,000/mo
- 151–200 beds$15,000/mo
- 201+ beds$22,000/mo
- Everything in state survey focus
- OIG / RAC / UPIC / TPE chart defense
- Live audit letter response & appeal prep
- Federal documentation reconciliation
- Priority turnaround & leadership briefings
Self-serve option
RevOptix1 platform only — no expert engagement
Prefer software-only? Subscribe directly at RevOptix1 with the same bed-count tiers. Upgrade to any PDPM Audit Group focus track when you need hands-on support.
Small
Under 75 beds
$3,500
/ month
- Unlimited audit defense
- RevOptix1 platform access
- MDS & documentation scoring
Medium
76 – 150 beds
$5,000
/ month
- Everything in Small
- Priority audit turnaround
- Enhanced compliance reporting
Large
151 – 200 beds
$8,000
/ month
- Everything in Medium
- Dedicated compliance specialist
- Monthly leadership briefings
Enterprise
201+ beds
$12,000
/ month
- Everything in Large
- Multi-facility analytics
- Custom integration support
All expert focus tracks use the same bed-count brackets as RevOptix1. Not sure which focus fits? Schedule a free consult or email audit-defense@pdpmauditgroup.com with your bed count and we’ll recommend the right track. (385) 888-7447
Why this exists
The average SNF administrator stays in the role for thirty-one months.
That is barely enough time to learn a building before the documentation culture you inherited becomes the documentation culture you are accountable for.
Most administrators sense something is off in their charts long before they can name it. They also know the wrong way to ask the question — too loudly, to the wrong person, in the wrong forum — can end a career.
We exist to give administrators a private mirror. Not a compliance dashboard. Not a vendor scorecard. A real, expert read of your records, delivered to you, in confidence, with the patterns explained in plain language and a path to fix them that does not put you in the line of fire.
The EMR problem
Your EMR does not have to cooperate.
Skilled nursing runs on a patchwork of charting systems — admissions in one, nursing in another, therapy in a third, MDS in a fourth, billing in a fifth. None of them reconcile. All of them are proprietary. And every one was sold to your operator with the promise of audit safety.
When OIG opens your records, none of that matters. They read what is actually there — across every system — and the data lockup your EMR vendors built into their products specifically to prevent third-party review does not protect you. It only delays your visibility into your own facility.
RevOptix1 does not require integration access. It does not require your vendor’s permission. It accepts whatever your EMRs can already produce — PDF exports, CCD documents, HL7 messages, FHIR R4 resources, plain text. It reads across all of them the way an auditor does, finds what does not reconcile, and tells you privately, before someone else asks.
What RevOptix1 delivers
Four things, from a single chart upload.
When you send us a record, we run it through RevOptix1 and return findings in four parts — each one immediately actionable, each one written in the language of the auditors that matter.
Recover revenue
Specific ICD-10 codes that should have been captured, with PDPM impact, dollar-per-day revenue, and confidence ratings. The dementia code that was missed. The systolic heart failure documented in the physician note but never coded.
Staff training
Tied directly to the chart you uploaded. Not generic compliance education. The MDS coordinator sees exactly what was written and exactly what to write next time, with the CMS-grounded language to use.
Compliance shield
Your audit defense, prepared in advance. For every flagged code, you get the documentation already on file, what needs to be strengthened, and a defense statement written in the language auditors expect. When the ADR letter arrives, you do not write a defense — you already have one.
30-day plan
Specific actions, assigned to specific roles, with timelines. Physician attestations to obtain. MDS sections to update. Wound documentation to complete. Each step shows the revenue impact and the audit risk it closes.
Methodology
The auditors we read for.
Most consultants know one or two auditors well. Usually OIG. Sometimes the RAC. We built RevOptix1 around the methodology of all of them.
OIGPost-payment recoupment behind the Pinnacle case.
RACRecovery Audit Contractor, post-payment claims review.
TPETargeted Probe and Educate, focused chart review.
MAC medical reviewPre- and post-payment review tied to coverage determinations.
UPIC / ZPICProgram integrity contractors, Medicare and Medicaid.
CERTCMS error-rate sampling.
MFCUState Medicaid fraud investigations.
State surveyorsThe deficiency record feeding every other auditor’s data.
RAI / MDS validationCase-mix and assessment accuracy review.
Commercial payer reviewPrivate and Medicare Advantage chart audits.
CMS validationRetrospective review for suspected systemic error.
Internal coding auditsVendor-led proactive and reactive review.
These programs share methods. They share data. They escalate to each other. RevOptix1 reads your records the way all of them read records — at the same time.
How an engagement works
Trust first. Then the chart.
i.
Confidential conversation
We talk before you upload anything. Nothing leaves the room.
ii.
Send us one chart
A single record, in whatever format your EMRs can export.
iii.
Findings, privately
Delivered only to you. Not your operator. Not your board.
iv.
You decide what is next
Single chart. Full audit. Staff training. Or simply space to act.
Tried several consultants before — PDPM Audit Optimization Group’s data analysis and training truly stand out. Insightful, practical, they really know their stuff.
Monica Chandler � Administrator, Long-Term Care
A confidential conversation costs nothing
Send us one chart. See what every one of your systems missed.
Per KUTV (6/24/2026), the DOJ charged 455 people in its 2026 National Health Care Fraud Takedown — $6.5 billion in alleged false claims across 45 states. A single chart, run through RevOptix1, will tell you where you stand.
Message us
Location
Smithfield, Utah
Response time
Most inquiries receive a personal reply within one business day. Active audit response receives same-day attention.