Mastering the CMS Program Audit Process Recap

Tracy Bidot, Conference Producer

Our recent Compliance and Audit Operations summit in Baltimore, Mastering the CMS Program Audit Process, headlined by CMS leadership and featuring Medicare Advantage health plan leaders, received an impressive turn-out and remarkable audience response.  Even esteemed headliner, Tawanda Holmes, CMS Director of Division Audit Operations, remarked that the summit featured some of the most educated, well-versed health plan compliance speakers. 

The event was kicked off by Ginger Morrow of Blue Cross Blue Shield of Tennessee leading a detailed pre-conference workshop on all things necessary for mastering FDR oversight initiatives, from setting-up oversight committees to conducting mock audits of your FDR oversight plan.  Day One started with an informative and engaging keynote address by Tawanda Holmes on CMS compliance audit strategy and policy updates emerging in 2014 and beyond, and also featured tremendous insights from LCDR Lorelei Piantedosi, PharmD, of CMS Division of Analysis, Policy, and Strategy.  

Throughout the day, attendees benefited from essential discussions on maximizing the mock audit, ensuring a compliance-ready culture, and instituting comprehensive compliance training programs.  Day One also included an enlightening examination of the CMS enforcement process presented by Michael DiBella, CMS Director, Division of Compliance Enforcement. 

Sarah Peix of Health New England and Sonya Henderson of Healthfirst set Day Two off to a tremendous start as they shared invaluable insights and lessons learned from their respective CMS Program Audit experiences.  In a second day full of meaningful compliance management sessions, presenters shared tools for conducting an impact analysis, ODAG and CDAG strategies, and how to use data management to support audit preparation. 

A special thank you to our extraordinary speaking faculty, who are clearly unparalleled leaders in MA Compliance and CMS Program Audit preparedness:


Tawanda Holmes, Director, Division of Audit Operations, CENTERS FOR MEDICARE AND MEDICAID SERVICES

Michael DiBella, Director, Division of Compliance Enforcement, CENTERS FOR MEDICARE AND MEDICAID SERVICES

Lorelei Piantedosi, PharmD, LCDR, Medicare Part C and D Oversight and Enforcement Group, Division of Analysis, Policy, and Strategy, CENTERS FOR MEDICARE AND MEDICAID SERVICES

Jennifer Del Villar, CHC, Director of Medicare Compliance/Compliance Officer, REGENCE

Jeff Deneys, Director, Detection & Monitoring - Operations Compliance, UnitedHealthcare Medicare & Retirement

Sonya Henderson, Vice President, Compliance and Audit, Compliance Officer, HEALTHFIRST

Michael Johnson, CIA, Internal Auditor, HEALTHPLUS OF MICHIGANTM

Mike Larkin, Medicare Internal Auditor, CAPITAL BLUE CROSS

Sarah Peix, Medicare Compliance Officer, HEALTH NEW ENGLAND

Gayle Pryde, RN, MBA, CHP, CHC, CCEP, CPHQ, CPHRM, Director, Corrections & Compliance - Operations Compliance, UnitedHealthcare Medicare & Retirement

Erik Schieren, Internal Audit, FLORIDA BLUE

Hillary Simpson, CPA, Internal Audit, FLORIDA BLUE

Patricia A. Suffern, RN, MPM, JD, Director Compliance, VIRGINIA PREMIER HEALTH PLAN, INC.

Steve Arbaugh, Managing Principal and CEO, ATTAC CONSULTING GROUP, LLC

Jody Stern, RPh, Program Manager, ATTAC CONSULTING GROUP, LLC

Laura Gleason, Chief Compliance Officer, BEACON HEALTHCARE SYSTEMS



Categories: Compliance
Tags: Audit

Log on to Your Rise Account

Forgot your password?
Create an Account


Latest Posts

CMS Gives EDPS Transition Some Breathing Room

CMS published the final call letter for 2018 yesterday, April 3, which included a welcome accouncement regarding the transition from RAPS to EDPS-based RAF scores. Citing numerous public comments on the subject, CMS throttled back the speed with which they plan to switch over to an encounter-based methodology. Instead of the blended rates originally contemplated, they announced that the more modest blend of 85% RAPS to 15% EDPS would be used in 2018, allowing more time to improve the reliability of the encounter data methods. While the RISE data collaboration study was not cited, we believe that the educational value of our study, along with our communication and advocacy of a more moderate approach by CMS, contributed to the confidence with which plans and other interested parties spoke up during the open comment period. Once again, we owe thanks to the folks at Avalere and Inovalon, as well as at AHIP, for the collegial and professional collaboration. Also, we want to thank the health plans that actively participated in our study for making this work possible. ...
Read More

Take Aways from RISE Nashville Summit

The 11th Annual RISE Nashville Summit continued the event’s tradition of yearly growth. The return to downtown Nashville was widely applauded by attendees, who were glad to be back near Broadway’s nighttime funk and fun. While festive, this year's event occurred in the wake of the new administration in Washington, D.C., and the healthcare themes surrounding the "repeal and replace" of the Affordable Care Act (ACA) cast a long shadow. In contrast to the upbeat, confident notes struck by last year’s keynote speaker Senator Tom Daschle, this year’s sobering keynote address by Howard Fineman, NBC/MSNBC political analyst, The Huffington Post Media Group global editorial director, and bestselling author, was an assessment of the pluses and minuses of our new president. Mr. Fineman's remarks indicated that the political alliances in power will seek to undo what Senator Daschle viewed as "irreversible” a year ago....
Read More

Upcoming Conference


Qualipalooza: The 2nd Annual RISE Quality Leadership Summit 

This unique event incorporates three conferences presented side-by-side: the Star Ratings Strategic Planning Forum, the HEDIS Forum, and the CAHPS, HOS & Member Survey Forum. Register for one conference for an in-depth examination of a single area, or design your own event by opting for the all-access pass and choosing the sessions from each conference which correspond exactly to your interests.


Upcoming Webinar

The Impact of Quality Incentive Models in Medicaid Markets


Thirty-one of our fifty states now have Medicaid managed care, and several markets are expected to implement managed care in the next few years. More than $160B in Medicaid spending occurs through the Managed Care Organizations. As more and more states seek to do more with less, increasing accountability for health quality outcomes is placed on health plans. Join this webinar to learn the typical quality payment approaches states use, issues often faced by health plans under each model and what states are expected to do with payment models tied to quality performance in light of near term Medicaid reform efforts.


Connect With Us

Copyright © 2014 Resource Initiative & Society for Education. All rights reserved.