Compliance Spotlight

Matthews & Stephens possesses a strong and unique network of Healthcare Compliance and Privacy professionals across the country.

Our placements have a wide range of experience in Compliance, Privacy, Security, Risk, Audit and Quality.

The profiles below are a representation of the Healthcare Compliance professionals with diverse backgrounds and varying levels of experience we work with daily.

Snapshots of our featured candidates . . .

 


Candidate Profile # 1


Compliance and Privacy Officer

This candidate currently serves as Market Compliance and Privacy Officer with a system consisting of six hospitals, four large physician group practices and several ancillary facilities.

This candidate enjoys being responsible for the development, growth and maintenance of an organization’s compliance and privacy program and always aspires to build the strongest compliance and privacy program possible in an environment that supports the same mission.

This candidate works diligently to increase the visibility of compliance/privacy: Reporting of incidents has increased by more than 500% at each facility that the candidate has worked at. This candidate accomplishes this by using an old principle called MBWA (management by walking around) which allows the staff to get to know the candidate. This candidate uses these opportunities to educate subtly and to create positive relationships so that people know who to contact with questions and concerns and are not afraid to do so.

This candidate also sets high standards for the organization so that risks are mitigated to the greatest degree possible. This candidate prefers to grow the compliance program using CIA guidance. As CIA guidance changes, this candidate implements those elements that make sense and are applicable to the organization that the candidate works for.

In the audit programs that this candidate has developed, they audit across the spectrum, not just seeking overpayments but any mis-billings, to include those that were missed opportunities. This candidate also advocates the use of data mining to audit efficiently and effectively.

This candidate has an MBA and a Bachelor of Science Degree in Technical Management. This candidate is certified in Healthcare Compliance.

 




Candidate Profile # 2

Chief Compliance & Privacy Officer, and Associate General Counsel

This candidate is an exceptionally well-rounded and accomplished healthcare legal and compliance leader. This candidate has significant experience in designing, implementing and administering enterprise compliance programs for prominent healthcare systems. The enterprise programs address compliance risks for hospitals, multi-specialty group practices, HIPAA privacy and security, clinical research and the False Claims Act, Stark Law and Anti-Kickback Law. The candidate’s pro-active and team building approach to compliance program implementation includes well-defined risk assessments, risk mitigation strategies and well received education and training programs.

This candidate has strengthened the hospital and physician compliance programs by introducing compliance software support,  delegated accountability based on risk assessments and focused audit and monitoring parameters, updating risk reporting metrics across the enterprise and improved matrix reporting to an executive compliance committee.  The programs led by this candidate also measured improved coding results in terms of reimbursement and placing greater emphasis on clinical documentation improvement

The organizations where this candidate has served include non-profit, proprietary, academic medical centers and a specialty hospital system.

This candidate is an attorney and is certified in Healthcare Compliance.




Candidate Profile # 3


System Compliance Officer

 
This candidate has a broad depth and breadth of healthcare compliance knowledge and experience including program implementation, upgrading policy, processes and communications, overseeing Code of Conduct and Conflict of Interest programs, privacy, fraud/waste/abuse and investigations as well as experience in the insurance “payer” space. This candidate has experience as a Compliance and Privacy Officer at a large and prominent hospital system and medical group and as Compliance Lead for a large academic hospital system and medical group. Responsibilities included implementing the compliance program, training, overseeing compliance research and reviewing applicable state and local government requirements.

This candidate reduced risks at the system’s teaching hospital through the implementation of a new research compliance initiative and saved costs for the health system through the release of internally developed, effective compliance education solutions.

This candidate has an MBA, and CPCO, CHC, CHPC and CHRC certifications.

 




Candidate Profile # 4

Vice-President Chief Audit & Compliance Officer
 

This candidate is well-seasoned with a great depth and breadth of experience in compliance, audit, finance and operations. The candidate has large healthcare system experience coming from a 5 hospital system with approximately 2,000 beds where the candidate was responsible for the Internal Audit and Compliance functions for multiple hospitals within the system as well as the Physician Organization and a Research Enterprise. The candidate managed a large staff including two directors, a manager and a research auditor and was responsible for the dotted line supervision of locational compliance & privacy officers and chaired the System Executive Compliance Council.
 
This candidate has a proactive service approach to compliance and audit and has the ability to obtain the support of senior management in the implementation of the compliance program which has resulted in improved efficiency, reduced costs and potential liabilities are avoided. With this candidate's active listening skills and practical approach the candidate is also able to obtain the support from physician leadership and the General Counsel.
 
In addition to being a CPA, this candidate also has an MBA with an emphasis in Accounting and Finance and a BA in Business Economics.




Candidate Profile # 5

Chief Compliance Officer


This candidate is an experienced compliance professional (healthcare and data protection) and attorney with several years of leadership experience in both evaluating and implementing programs which identify deficiencies, fraud, abuse, waste and integrate efficiencies within organized operations. This candidate has experience working as a government Regulator, as well as a Chief Compliance, Information Security, and  Privacy Officer, and as SME/Consultant for non-profit and for profit entities.

This candidate has a proven track record of delivering cost-effective, timely healthcare compliance program evaluation, remediation, and management (Fraud Abuse, Anti-Kickback, False Claims, Red Flags), HIPAA (Privacy/ Security), Privacy Act, privacy and security compliance remediation services, and Meaningful Use Assessments, for Covered Entities such as large health systems, managed care organizations, hospitals, physician practice groups, accreditation organizations, data management organizations and research organizations.

This candidate has done consulting work and has served as a Subject Matter Expert to various clients. The candidate is well versed in the False Claims Act, Stark Laws, Red Flags, Privacy Act, HIPAA Privacy and Security, FISMA Compliance, the Freedom of Information ACT (FOIA) requirements, as well as the Affordable Care Act's Meaningful Use Requirements.  This candidate also has experience performing the tasks necessary to and to successfully complete Data Use Agreements (DUA’s), and Privacy Impact Assessments (PIA).

In addition to having a JD, this candidate also has a Master’s Degree in Health Policy Management and a Bachelor of Science Degree in Business Administration and Finance.

 



 Candidate Profile # 6


General Counsel/Corporate Compliance Officer



This candidate’s legal career has been spent solely in a healthcare environment and the candidate has litigated complex medical malpractice matters for over a decade. More recently, this candidate has become more engaged on an operational level at the hospital level; working with physicians, employees, patients and families.

This candidate served in a dual role as General Counsel and Corporate Compliance Officer for a 500 bed for profit community hospital system and led the company through two hospital acquisitions and a recapitalization, managing all due diligence, compliance and regulatory matters. This candidate is exceptionally skilled in negotiation and contracting, regulatory and compliance and as a corporate advisor. This candidate has developed and implemented a corporate compliance program where none existed. This candidate ensured all hospitals in the system achieved accreditation and regained CMS deemed-status twice. This candidate monitored a HIPAA regulatory process and despite an instance of an accidental breach of over 500 names, avoided the mandatory fine because of the timely and efficient manner in which the breach was handled.

In addition to having a Juris Doctorate, this candidate also has a Bachelor of Science Degree in Biochemistry and Physiology.

 




 
Candidate Profile # 7

Chief Compliance Officer


This candidate has progressive growth in healthcare compliance, privacy, security and internal audit.  This candidate enjoys both assessing existing compliance programs and starting programs from scratch with the goal to always bring that health care system’s compliance program to be the best in the industry.
 
This candidate feels the success of compliance relies on the four C’s of compliance: 1) Communication, 2) Collaboration, 3) Culture and 4) Credibility. The candidate has 15 years of compliance, audit, privacy and security experience and currently reports to the organizations Board of Trustees with a dotted line reporting structure to the President and CEO. The candidate has worked in large health care systems and, most recently as a stand-a-lone Chief Compliance Officer.  
 
The candidate has developed and implemented a comprehensive Conflict of Interest Policy survey process. After automating the survey and making some key revisions it had two years of 100% completion. This has not only saved time, but has resulted in employees and physicians asking conflict of interest questions prior to making certain decisions.

The candidate led an investigation that resulted in the hospital system settling with a vendor for $9 million. The candidate has excellent oral and written communication skills.

This candidate has CHC, CCEP and CHPC certifications and a Bachelor of Science Degree in Business Administration.


 




 
Candidate Profile # 8

Director- Research Quality Assurance


This candidate has 30+ years of diverse, high level administrative and management experience. The candidate has extensive experience in research contracting in the areas of academic, state, federal, human subject, basic science, private consulting and pharmaceutical research, program administration, management of large and innovative new initiatives, research compliance, research administration and management, technology transfer development and liaison responsibilities with federal and state agencies, university administration and faculty, private consulting firms and pharmaceutical companies. This candidate is a recognized leader in developing new programs, conducting peer reviews, regulatory compliance, managing budgets and resource allocation. The candidate has the proven ability to manage staff and is recognized as a mentor for staff development.

This candidate is experienced in managing and initiating research compliance activities, including the consideration of risks as well as impacts and implications and is experienced in the areas of academic, basic science and animal laboratories. The candidate is an experienced trainer and has developed, established and provided training materials, programs and other tools for Research Investigators, Study Coordinators, Research Administrators and all laboratory staff to improve safety and the quality of research results and data. This candidate has reviewed, revised and developed Institutional Policies to maintain adherence to laws, regulatory guidelines and best practices.

This candidate holds a Master of Public Administration and a Bachelor of Arts Degree in Government and Politics.


 





Candidate Profile # 9

Director of Integrity and Compliance


This candidate is an attorney and experienced mediator with a broad depth and breadth of experience in academic institution research compliance as well as a strong consulting background. This candidate’s leadership roles range from rather narrow programmatic issues such as revising compliance policy and procedure to Institution wide concerns such as safety, accreditation, strategic planning and diversity committees. The candidate has also managed teams in both supervisory and chair capacities.

This candidate feels comfortable with traditional hospital compliance as well as research compliance and has also worked in hospitals and has litigated and mediated healthcare issues in both tort/malpractice arenas and regulatory concerns. The candidate is comfortable with regulatory interpretation and has represented clients before regulatory boards.

This candidate is an experienced trainer, presenter and educator. The candidate presents information about compliance, research integrity and regulatory interpretations to groups of students and faculty, to college wide assemblies of faculty, and to regional groups of professionals, with audiences ranging from 3 to 100. The candidate has provided trainings on a diverse range of topics and has delivered trainings live, face to face, via webinar and via asynchronous recorded technology. As an adjunct faculty member, the candidate has also taught numerous courses such as Law and Ethics in Public Policy, Research Regulation Law and Research Litigation.

In addition to having his JD this candidate also has a Master’s Degree and is a Certified IRB Manager (CIM) and a Certified IRB Professional (CIP).




 





Candidate Profile # 10


Market Compliance Officer


This candidate is responsible for the overall compliance program of two hospitals (a 500 bed and a 200 bed) in a large for profit system, answering to the CEOs and governing boards of the two hospitals as well as the system’s corporate compliance officer.  This candidate currently manages all compliance functions without the assistance of local support staff, and his personal mission and vision is to improve his market's culture of compliance.

His primary areas of focus include risks associated with coding and billing, quality of care, medical necessity, financial relationships with referral sources, patient rights (including HIPAA/privacy), assuring qualified and fit staff, and hospital regulatory compliance. He overseas specific regulatory requirements associated with the hospital's inpatient psychiatric treatment and inpatient rehabilitation units, and the clinical research program. His support of the organization’s top strategic goal of offering a high quality of care to their patients by directly involving himself in effective and appropriate corrective action planning in the wake of any patient safety events, has contributed toward his facility's "A" ranking in recent Leapfrog Group hospital quality comparisons. His identification and understanding of issues representing greater potential risk to the organization allows him to focus his time more meaningfully for the hospitals. This candidate has also successfully guided the facilities through the system’s rigorous Corporate Integrity Agreement, including numerous Independent Review Organization (IRO) audits.

This candidate has an MBA and is certified in Healthcare Compliance


 






Candidate Profile # 11


Compliance & Privacy Officer and General Counsel
 

This candidate is an exceptionally experienced Compliance and Privacy Officer; he’s both an attorney and a CPA and has a Master’s Degree in Health Policy and Management. He’s very well-tenured and is responsible for the development and maintenance of the General Counsel, Corporate Compliance and Internal Audit functions at a 300+ bed nonprofit hospital.

This candidate established and developed the hospital’s Medicare, Medicaid and HIPAA  Compliance programs as well as the hospital’s first internal audit function and provides ongoing training to the members of the board, medical staff and employees.

This candidate’s accomplishments include the successful conclusion of two qui tam actions brought against his organization without any further action, demand or sanction by federal or state government against the organization including, but not limited to imposition of a Corporate Integrity Agreement. This outcome was the result of both the federal and state government’s recognition of the effectiveness of the organization’s Corporate Compliance Program which he established. He also developed and established an in-house general counsel function which resulted in a significant reduction in fees paid to outside counsel and consultants for legal and compliance services.



 






Candidate Profile # 12


Corporate Compliance Officer


This candidate has 13 years of experience in compliance having served as Medical Auditor, Director of Revenue Integrity and Compliance Officer. This candidate is also an experienced RN.

This candidate has solid knowledge of healthcare related laws and regulations including Stark, Anti-kickback, False Claims Act, HIPAA, EMTALA as well as OIG Work Plans and Federal Sentencing Guidelines. He also has experience working under a Corporate Integrity Agreement.

This candidate is a strong leader having previously managed approximately 60 employees and maintained budgets across several hospital units. He’s revised/revamped Compliance Programs and provides compliance training to all employees at his system. As Director of Revenue Integrity, this candidate helped in the implementation of changes in the hospital’s Chargemaster as well as identified inconsistencies in the ancillary system interfaces that resulted in a large net revenue increase.

This candidate has a Master of Science in Nursing, is a Certified Fraud Examiner and is certified in Healthcare Compliance.
 

 

Please visit us often as our spotlight profiles are updated regularly.


Feel free to contact us if you have any questions.
Steve Baskowski (860)258-1995 x19 sb@matthews-stephens.com
Carrie Lombardi (860)258-1995 x21 cl@matthews-stephens.com