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Pillar vii · Strategic Advisory
vii

The work that happens before audit defense becomes the conversation.

M&A diligence · growth · fractional leadership

Owners, CEOs, CFOs, and boards engage us when the situation is forward-looking — a new line of business, an expansion, a sale process, a leadership transition. We bring the same case-file methodology that defends operations under audit and apply it before exposure exists. Diligence, design, fractional leadership, governance build-out. When the standard you want is the one a regulator would set, we work the case that way from day one.

Sub-services within this hub
  1. M&A diligence — compliance, RCM, regulatory. Provider-side and PE-side diligence with the contractor-methodology lens. Surface the exposure the data room doesn't reveal.
  2. Growth strategy & operational design. New-line standup, expansion planning, multi-site operational design. Built compliant from day one.
  3. Compliance program design from scratch. OIG-aligned program build for new entities or material restructuring. Not a binder — an operating program.
  4. Fractional Chief Compliance Officer. Senior compliance leadership without the full-time hire. Board reporting, oversight, program ownership.
  5. Fractional Privacy Officer / HIPAA Security Officer. Required-by-statute role coverage for organizations that can't yet justify the headcount.
  6. Interim Revenue Cycle leadership. VP RevCycle, Director of Billing during transitions, integrations, or vendor changes.
  7. Board & governance advisory. Compliance committee design, board reporting framework, governance documentation that holds at examination.

The engagement

What you receive

What changes when we work the case:

  • M&A diligence surfaces real exposure before close. Indemnification scope and price both informed by the operational reality.
  • Expansion launches compliant from day one. No retrofit, no scramble, no day-30 surveyor finding.
  • Senior compliance presence at fractional cost. Board reporting, oversight, and program ownership at the level the role actually requires.
  • Transitions preserve the methodology. The work product survives the founder, the executive, or the ownership change.
  • Governance that holds at examination. Compliance committee, board reporting, and documentation that withstands regulator review.

Regulatory context

The rules this work is built to.

U.S. health services M&A topped $60 billion in 2024 (PwC Health Services Deals Insights), and the regulatory layer now reaches the deal itself: the 2026 enrollment moratoria restrict certain changes in majority ownership, making CHOW timing and structure diligence questions, not closing mechanics. OIG’s compliance guidance puts program effectiveness squarely on boards and owners.

Forward-looking work — diligence, program design, fractional compliance leadership — is the same case-file methodology applied before exposure exists rather than after it surfaces.

Questions

From the case file.

How does Strategic Advisory differ from your audit defense work?

Audit defense is reactive — a regulator or contractor has surfaced an issue. Strategic Advisory is forward-looking — we work the same methodology before exposure exists. Diligence before close. Program design before launch. Fractional leadership before the gap creates risk.

Do you do fractional Compliance Officer work for small organizations?

Yes. Single-site practices and multi-state networks both. The scope scales; the seniority of the role does not. A fractional CCO at Precisian carries the same authority and reporting structure as a full-time CCO.

Can you support an active M&A diligence on a compressed timeline?

Yes. Compliance and RCM diligence typically delivers in three to five weeks at full scope. Faster timelines available for active LOI situations with appropriate scoping.

What does this cost?

Diligence engagements scoped to deal size and complexity. Fractional leadership typically retainer (monthly). Program design flat-fee or phased. Scoping memo in week one before any meaningful commitment.

How quickly can you start?

Standard intake within five business days. Active diligence or interim leadership transitions within 48 hours where required.

Related provider types

Who we do this work for.

Hospitals

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Physician Practices

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Nursing Facilities

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Behavioral Health

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When the matter is consequential

We work the case the same way.

30 minutes. No pitch. We open the case file together — and recommend the next step.

Book a 30-min discovery callExplore our four audiences