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Improving revenue through compliance ...continued from page 13 Figure 2: Advance Beneficiary Notice (ABN) Form January 2006 14 Health Care Compliance Association • 888-580-8373 • www.hcca-info.org
feature article Editor’s note: This interview with Greg Jones was conducted by Roy Snell, HCCA CEO in early December 2005. For general Medicare information, including the Prescription Drug Benefit, please contact 1-800-MEDICARE or visit our website at www.medicare.gov. To report any suspected Fraud, Waste, and Abuse in the Medicare Part D Prescription Drug program, please contact 1-877-7SAFERX or e-mail MEDICinfo@healthintegrity.org Office of Counsel to the Inspector General where I was responsible for negotiating and monitoring Corporate Integrity Agreements (CIA) for a wide range of health care provider types, including hospitals and pharmaceutical manufacturers. In that role I regularly conducted site visits to providers operating under CIAs. Conducting site visits was my favorite part of that job because it gave me the opportunity to see first hand how various providers were implementing and maintaining their compliance programs. Meet Greg Jones Law Enforcement Liaison– Prescription Drug Benefit–Program Integrity Group, Centers for Medicare & Medicaid Services RS: Greg, what is your title, and would you briefly describe your responsibilities with the Centers for Medicare and Medicaid Services GJ: I am the Law Enforcement Liaison for the Division of Medicare Modernization Act Integrity within the Program Integrity Group. My primary responsibility is to coordinate with law enforcement on program integrity matters related to the Part D prescription drug benefit. In addition, I am the Team Lead on developing CMS’s Fraud, Waste, and Abuse Guidance for the Part D Plans. RS: What is your background and previous work experience GJ: Formerly, I was with the Department of Health and Human Services (HHS), At the OIG I also had the pleasure of working closely with HCCA to coordinate Government-Industry outreach and education efforts which included two separate industry roundtables. Prior to transferring to the Office of Counsel to the Inspector General, I was with the OIG’s Atlanta Office of Evaluation and Inspections where I led national studies uncovering over $8M in fraud, waste, and abuse in the Medicare program. RS: So tell us about your first year at CMS. GJ: This is a very exciting time at CMS; the implementation of the Medicare Modernization Act, including the drug benefit, is the most significant change to the Medicare program since its inception in 1965. It truly is an honor and an amazing professional growth experience to be a part of this historic event. I started in March 2005 and have been going full speed since day one. My first project was reviewing the compliance plan and business Health Care Compliance Association • 888-580-8373 • www.hcca-info.org integrity sections of the Part D Plan applications. Collectively, our division reviewed over 400 Part D Plan applications. I spent this summer training the OIG’s investigators, FBI agents, and Assistant United States Attorney’s about the drug benefit to help prepare them to investigate and prosecute potential fraud, waste, and abuse in the drug benefit. Most of my time this Fall has been spent drafting the Fraud, Waste, and Abuse Guidance for the Part D Plans. These are just the highlights— in between I’ve also been learning about the intricacies of the drug benefit, keeping track and following up on various Part D complaints, and assisting with the planning of Continued on page 16 15 January 2006
Page 1 and 2: Volume Eight Number One January 200
Page 3 and 4: ASK ON THE LEADERSHIP ONCALENDAR JO
Page 5 and 6: Join us for the following HCCA Audi
Page 7 and 8: in 2006 will assess hospital compli
Page 9 and 10: By Susan C. L. Theuns Editor’s no
Page 11 and 12: ■ ABNs were used for preventive c
Page 13: Figure 1: ABN Reference Guide Servi
Page 17 and 18: GJ: Yes. The Fraud, Waste, and Abus
Page 20: ■ There will be Compliance expert
Page 23 and 24: Here’s your chance to share your
Page 25: espective nonprofit law compliance
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Page 31 and 32: By José A. Tabuena JOSÉ A. TABUEN
Page 33 and 34: AP: As far as the Auditing and Moni
Page 35 and 36: that would provide the intelligence
Page 37 and 38: Case study of Dana Farber Cancer In
Page 39 and 40: JOSEPH M. WATT ■ Solicit staff an
Page 41 and 42: including the three objectives set
Page 43: expect a measurable impact of compl
Page 46 and 47: New HCCA Members ...continued from
Page 48: C ORPORATE C OMPLIANCE & ETHICS: G

MD - Health Care Compliance Association

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