IMHIRS Analytics provides clinical payment integrity audits, risk adjustment validation, and healthcare fraud detection for payers, self-funded employers, and health plans. Founded by a PA-C with 14 years of clinical practice and a master's in health informatics.
About
Dawn Krysa, PA-C, MSHIIM, CHDA is the founder and principal consultant of IMHIRS Analytics. After 14 years of clinical practice in primary care and internal medicine, she transitioned into healthcare data analytics with a focus on the problems that require both: reading a clinical record and knowing what the code should say.
Most analysts can run a query. Most clinicians can read a chart. Very few can do both at the level that catches what TPAs, AI platforms, and automated auditors miss. That intersection is where IMHIRS operates.
Services
Every engagement starts with a clinical question. The data answers it.
For self-funded employers and TPAs. Review high-dollar claims against clinical documentation to determine whether the procedure billed matches what the record supports. Catches what fee schedule review cannot.
Per-claim or retainer engagementIdentify missed, unsupported, or incorrectly coded HCC diagnoses across Medicare Advantage populations. Validate RAF scores against clinical documentation. Quantify confirmed revenue impact.
Per-patient or population-level engagementAI CDI tools miss complex, multi-encounter diagnoses that require clinical synthesis. Independent audit of platform outputs (Keebler, Ambience, Iodine) for false negatives requiring clinician judgment.
Project-based engagementStatistical outlier detection on CMS utilization data using clinically-informed thresholds. Identifies billing patterns that exceed clinical plausibility. Methodology validated at 71% pre-charge confirmation rate against DOJ enforcement actions.
Project-based engagementTargeted clinician education on documentation requirements for HCC capture, medical necessity support, and coding accuracy. Designed for LTC, primary care, and Medicare Advantage provider networks.
Per-session or program engagementCMS FOIA referral data analysis to identify network leakage patterns. Health system financial and governance analysis. Population health analytics for MA I-SNP and ACO environments.
Project-based engagementCustom RAF calculation tool built for Medicare Advantage populations. Validates HCC-to-RAF point mapping and projects revenue impact of confirmed coding opportunities.
Licensing availablePortfolio
Every case below represents a real finding from independent research or client engagement. Names and identifying details de-identified where required.
Analysis of 9.66 million row CMS Medicare Physician and Other Practitioners dataset using clinically-informed billing thresholds for amniotic membrane allograft products. Identified 145 providers billing at clinically impossible volumes. Southern California physical therapist cluster flagged based on identical unit pricing ($1,215.20/unit Q4281) across unaffiliated NPIs, indicating shared distributor network. Arizona cluster of confirmed defendants identified prior to DOJ action.
[VERIFIED — DOJ CONFIRMED]AI CDI platform (Keebler) failed to flag active osteomyelitis in a post-amputation patient across multiple encounters. Clinical synthesis of wound care notes, lab trends, and imaging confirmed M86.172 — HCC 39, 0.974 RAF points. Estimated $10,000-$12,000 annual revenue impact. Required multi-encounter chart review that automated tools cannot perform.
[VERIFIED — CONFIRMED OPPORTUNITY]Identified pattern of F19.20 (other psychoactive substance dependence) being applied across multiple LTC facilities based on antidepressant medication presence, with no DSM-5 clinical documentation supporting substance use disorder diagnosis. Escalated to clinical leadership for system-wide correction. Protects plan from RADV audit exposure.
[VERIFIED — ESCALATED AND VALIDATED]Complete CDI validation across 332 patients, 12 LTC facilities in Kentucky. Confirmed $407,230/year in missed HCC coding opportunities. Top patterns: CKD staging (N18.xx), obesity triple-coding (E66.xx + Z68.xx + BMI), respiratory conditions. First three weeks of engagement: $125,000-$160,000 confirmed across three facilities.
[VERIFIED — CONTRACT ENGAGEMENT][VIEW FULL METHODOLOGY ON GITHUB] github.com/IMHIRS-analytics →
Contact
Engagements begin with a no-obligation discovery call. Whether you're a self-funded employer with a claim that doesn't add up, a health plan looking for independent CDI validation, or a payer-side team building a fraud detection program, the conversation starts here.