Corporate Compliance

Client Situation 1

A worldwide market leading manufacturer and distributor of high tech medical devices had just settled with the government for overcharging the Veterans Administration (VA) in violation of the “most favored customer clause” under the Federal Acquisition Regulation (FAR). As a result, the client realized it needed a more robust contract management system and corporate-wide Contract Review and Administration Policy and called on us to help.

Core Competency: Regulatory (FAR and Uniform Commercial Code (UCC)), Contract Administration & Process Review

Consulting Objectives:

• Develop a policy and process for systematically and efficiently managing contract creation, execution, and analysis for the purpose of maximizing financial and operational performance and minimizing risk.
• Assist the client with vendor evaluation and selection for a contract management portal that would accommodate both corporate headquarters and the client’s many international locations and sales offices.

Approach:

• Conduct process review / risk assessment and perform gap analysis
• Evaluate existing policies and internal controls over the approval, review, and administration of contracts
• Close communication gaps between contracting departments and operating areas responsible for administering the agreements.

Outcomes:

• Comprehensive Contract Review and Administration Policy governing contract initiation, review and approval, execution, and post-execution maintenance and management.
• Review matrices for sales contracts, service and warranty agreements, research and development contracts, purchase agreements, real property, and personal services agreements.

Client Situation 2

A leading, not-for-profit HMO with Medicare+Choice and Medicare Cost products engaged us to conduct a re-audit of the Center for Medicare and Medicaid Services’ (CMS) findings during its latest annual review.

Core Competency: Regulatory (Medicare Contractor Performance Standards), Health Plan Administration, & Process Review

Consulting Objectives:

• Confirm or refute CMS’ audit findings.
• Identify operational deficiencies and provide recommendations for improvement.
• Develop a comprehensive corrective action plan for submission to CMS.

Approach:

• Re-audit files selected by CMS for its annual review in accordance with standards provided in CMS’ Contractor Performance Monitoring System and CMS’ Medicare+Choice Monitoring Guide.
• Using our proprietary “life-cycle” approach, conduct an operations review / risk assessment. Areas reviewed included: Plan Administration & Management, Marketing, Applications and Enrollment, Membership, Disenrollment, and Claims Processing.

Outcomes:

• Development of a comprehensive corrective action plan and ongoing auditing and monitoring program.
• Training and education for internal audit staff on conducting annual CMS’ “mock” audits and performing monthly and quarterly audits in select areas.