Auditing of Medicare Advantage Health Plan Marketing and Sales

This training will review the updated regulatory standards for marketing and sales of Medicare Advantage Health Plans. It will highlight critical, but often overlooked, compliance risk areas in the oversight of Medicare Advantage marketing and sales departments and functions.

Who will benefit:

HMOs, medical groups, IPAs, MSOs, ACOs, governmental organizations, insurers, hospitals, academic medical centers, medical offices, practice groups and business associates (shredding, data storage, systems vendors, billing services, etc). The following personnel will benefit:

• Compliance director
• Chief Executive Officer (CEO)
• Chief Financial Officer (CFO)
• Chief Operating Officer (COO)
• Chief Marketing Officer
• Director of Sales
• Director of Marketing
• VP, EVP, SVP of Marketing or Sales
• Internal Auditors
• External Auditors
• Healthcare Counsel/lawyer
• Office Manager
• Contracts Manager

Instructor Profile:

Jeffrey Baron, MBA, CCEP, CHC, is Principal , Healthcare and Management Consulting at Strategic Healthcare Associates -Baron Global Ventures, LTD.

Compliance, Special Investigations, and Organization Risk Analyses and Gap Analyses: 19+ years of developing, revising, and or effectuating health plan compliance programs, overcoming regulatory challenges, development or renewal of special investigations & antifraud-waste-abuse program units, as well as implementing new legislation or programs.

Healthcare Leadership & Management: 15+ years experience managing provider and network development, contracting, compliance & operations, auditing, and providing leadership for healthcare organizations and facilities, including Healthcare Plans, Health Maintenance Organizations (HMOs), including Medicare Advantage, Medicaid / Medi-Cal, and commercial lines of business, IPAs, and PHOs.

Developed Compliance training programs, and communications to implement new laws and initiatives, for risk management reduction, or for corrective action. Including:

• HMO internal and delegated provider network statutory training programs for compliance and network development purposes, while increasing attendance by 250%, and reducing overall costs by 300%. Program Developer and organizer for health-plan
• Producer of regional Provider Compliance and Anti-Fraud –Waste –Abuse Training Seminar and Workshop
• Network Development, Contracting, Strategic Development, and Provider Relations:

Healthcare Organizational Change & Transformation:

• Medicare Part D Medicare Advantage implementation task-force that created new Medicare Part D program.
• Consultation to governments, investment banking firms, which included privatization, health system development & regulatory develop of system structuring for new healthcare laws and regulations.