RISE National will head to San Antonio, March 11-14, for four days of learning and networking. Sessions will dig deep into hot topics, regulatory compliance, risk adjustment strategies, integrating silos, quality and member experience, payer/provider strategic alignment, technology/data analytics, and the future of health care. Among the featured government speakers at the annual Medicare Advantage mega conference: Six representatives from the Department of Health and Human Services (HHS) Office of Inspector General (OIG).
Deputy inspector general on cultivating trust in Medicare Advantage
Ann Maxwell, the deputy inspector general for evaluation, will take the main stage Thursday morning, March 13 to share her vision for cultivating trust in Medicare Advantage.
Her presentation will address OIG’s commitment to ensuring that the Medicare Advantage program delivers cost-effective, high-quality care for the millions of enrollees who rely on it by focusing on the future of the Medicare Advantage program and what steps plans can take now to ensure managed care lives up to its potential.
She’ll discuss how plans and others can build trust and elevate integrity through compliance, including how plans can use OIG’s oversight and program integrity tools to focus on key gaps where managed care has tremendous opportunities to earn trust and reduce risk.
About Maxwell
Maxwell leads the office in producing results-oriented evaluations that provide valuable insights into the efficiency and effectiveness of HHS programs as well as offer actionable recommendations to drive positive change in HHS programs so that they can better serve and protect the American people. Maxwell also leads OEI in its oversight of the State Medicaid Fraud Control Units (MFCUs), which investigate and prosecute providers for Medicaid fraud as well as for abuse and neglect of patients in health care facilities. In fiscal year 2021, the MFCU grant program recovered $1.7 billion—a return of $5 for every $1 invested.
As the head of the Office of Evaluation and Inspections (OEI), Maxwell leads more than 150 professionals who provide objective, reliable, data-driven evidence to HHS, Congress, and the public on significant issues. She leads the office in producing results-oriented evaluations that provide valuable insights into the efficiency and effectiveness of HHS programs as well as offer actionable recommendations to drive positive change in HHS programs so that they can better serve and protect the American people. Maxwell also leads OEI in its oversight of the State Medicaid Fraud Control Units (MFCUs), which investigate and prosecute providers for Medicaid fraud as well as for abuse and neglect of patients in health care facilities. In fiscal year 2021, the MFCU grant program recovered $1.7 billion—a return of $5 for every $1 invested.
Regulatory compliance: OIG panel to provide updates and guidance for managed care
Later that day, panelists from OIG will discuss recent and ongoing audits and evaluations of Medicare Advantage plans that continue to raise concerns about the accuracy of risk adjustment data and payments. They will also review compliance issues for managed care and examine recent fraud cases and trends.
OIG speakers will include Jacqualine Reid, social science analyst, Office of Evaluation and Inspections; Sarah Kessler, senior counsel, Office of Counsel to the Inspector General; Carolyn Kapustij, senior advisor for managed care, Office of Audit Services; Isaac M. Bledsoe, director of strategic projects and initiatives, Office of Investigations; and Christopher G. Bresette, director of Medicare Part C audits, Office of Audit Services.
About Reid
Reid is a team leader and social science analyst for HHS-OIG. She has provided significant contributions to national program evaluations on a range of issues affecting HHS programs, including Medicare program integrity and Medicare Advantage encounter data. She currently leads efforts to examine potential vulnerabilities within Medicare Advantage. Prior to OIG, she worked at the National Institutes of Health Clinical Center, evaluating occupational health and patient safety practices. She holds a Ph.D. in anthropology, focused on health and public policy, from American University.
About Kessler
Kessler has served as counsel for HHS-OIG since 2011, working on civil and administrative matters involving managed care and various other health care providers. Before she began her career in government service, Kessler worked as an attorney in a health care practice group at a law firm.
About Kapustij
Kapustij serves as a senior advisor for managed care at HHS-OIG. At OIG, she develops and leads enterprise-wide strategies to oversee Medicare Advantage and Medicaid Managed Care programs. She previously worked at the Centers for Medicare & Medicaid Services (CMS) and oversaw the improper payment measures for Medicare Part C and Part D, developed program integrity activities for the Federally Facilitated Exchanges, and developed payment policy for Medicare Advantage and Medicare Part D plans. She holds a Master of Public Health from the University of Michigan.
About Bledsoe
Bledsoe is a special Agent with HHS-OIG and currently serves as an operations officer within the Investigations branch at OIG’s headquarters. His duties and responsibilities include oversight into various programmatic areas including the Department of Justice’s Strike Force Operations, Medicare Part C, and the Office of Refugee Resettlement.
His work prior to coming to OIG’s headquarters included conducting complex investigations involving violations of criminal, civil and administrative law regarding HHS funds and beneficiaries (specifically in the areas of genetic testing, telemedicine, DME, home health, managed care and COVID-19 related pandemic frauds). He previously served as a special agent with the United States Air Force Office of Special Investigations (AFOSI) and was an officer in the United States Air Force. Bledsoe holds a Bachelor of Science degree in criminology and criminal justice from the Florida State University and a master’s degree in family, youth, and community sciences from the University of Florida.
About Bresette
Bresette is the director of Medicare Part C Audits with HHS-OIG, Office of Audit Services. Bresette is responsible for the implementation and coordination of all audits of the Medicare Advantage program and, based on more than 30 years of experience, provides expert advice to other auditors about the design and execution of those audits. Bresette has a wealth of knowledge regarding other HHS programs, including traditional Medicare and Medicaid, and has conducted several audits designed to detect and prevent fraud, waste, and abuse.
He also provides training to new and experienced auditors about the Medicare Advantage program. Bresette graduated with honors from Rockhurst University with a BSBA in accounting and is a certified public accountant, licensed in Missouri. Bresette has received numerous exceptional achievement awards and was awarded the Inspector General’s Bronze Award for the outstanding auditor of the year.
RISE National will take place March 11-14 in San Antonio. Click here for the full agenda, roster of speakers, and registration information.