OIG Modernized Medicare Advantage Compliance Guidance: Key Updates, Provider Risks, Evaluating Compliance Programs

Ms. Hiller focuses her practice on regulatory and legislative issues concerning health care payers, providers, and manufacturers. She has experience representing clients across the health care industry on policy matters, with a focus on Medicare Advantage and Part D, Medicare fee-for-service payment rules, interoperability and price transparency, and federal insurance oversight. Ms. Hiller previously served at the Centers for Medicare & Medicaid Services (CMS), where she was most recently the administrator’s senior advisor for Medicare. She advised the administrator and other senior agency officials on all parts of Medicare and also led initiatives related to health care price transparency. Earlier in her time at CMS, Ms. Hiller was the director of the Medicare Parts C and D Analysis Group in the Office of Legislation, where she managed interactions between the agency and Capitol Hill on a portfolio of issues including provider integrity. From the Office of Legislation, she worked closely with staff for the Senate Finance, House Ways & Means, and House Energy & Commerce Committees on legislative priorities and Administration policy.

Ms. Sorensen builds on her previous experience at the Office of Counsel to the Inspector General of the Department of HHS to assist clients with health care regulatory, compliance, and fraud and abuse matters. She focuses her practice on health care fraud and abuse and compliance matters, including the Anti-Kickback Statute. Ms. Sorensen assists clients in False Claims Act investigations, negotiating FCA settlements and corporate integrity agreements, and matters that fall under the Civil Monetary Penalties Law and OIG exclusion authorities. She helps clients develop compliance programs and implement corporate integrity agreements. Ms. Sorensen previously served as chief of the Administrative and Civil Remedies Branch in the Office of Counsel to the Inspector General (OCIG) at HHS. She served as the OCIG’s coordinator for both the Provider Self-Disclosure Protocol and the Physicians at Teaching Hospitals national project and also served the OCIG as senior counsel and deputy branch chief.

Ms. White is vice president of Revenue Management Compliance for Kaiser Foundation Health Plan, Inc. (KFHP) and Kaiser Foundation Hospitals (KFH). In this role, she is responsible for establishing and implementing an effective compliance program to support compliance with state and federal laws and regulations, as well as KFHP/KFH policies and procedures related to patient care, documentation, coding, revenue cycle, and risk adjustment activities. Ms. White joined Kaiser Permanente in January 2019 and reports directly to the senior vice president and chief compliance and privacy officer. Before joining Kaiser Permanente, she was the director, Regulatory Compliance at Anthem, Inc. In this role, Ms. White was responsible for planning, implementing, and overseeing regulatory, compliance, and risk management strategies for Medicare (Part C) risk adjustment activities.