MD - Health Care Compliance Association

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Editor’s note: This interview with Greg
Jones was conducted by Roy Snell,
HCCA CEO in early December 2005.
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please contact 1-800-MEDICARE or
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and Abuse in the Medicare Part D
Prescription Drug program, please
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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
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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