202 Building the Airplane as You Fly: FDR and Vendor Oversight at a MA Start-Up and What Happens after Wheels Go UP!

Kenneth Nuñez, Chief Compliance Officer, Provider Partners Health Plans.

2024-01-30

  • Day 0: Navigate the intimidating world of identifying and negotiating with FDR and delegated vendors before launch date, including issues around contracting, pre-delegation audits, network adequacy, and compliance program effectiveness of partners

  • Implementation: The importance of involving compliance in each implementation stage including system configuration, CMS required mailings, call center operations and delegating or retaining A and G

  • Go Live and Hair on Fire! Determining who has ultimate responsibility over the FDR and delegate after go-live: Should it be Compliance, Procurement, Operations, or a team-based approach?

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