MICHAEL KOTCH Director

CFE, CMAS, CFCE

 

Some believe that there is just one way of getting into compliance, and then you get locked in to one dimension. What are your thoughts?

There are always certain core aspects of your education and experience that are transferable. I believe that many of the skills you acquire throughout your career are transferrable from industry to industry. Take management as an example. Managing day-to-day business activities, managing people, managing budgets, managing customers, and managing products and services are processes that are common in all industries. Other examples include accounting, customer service, computer programming, data analysis, quality and process improvement, project management, and human resources. I highly recommend searching for the commonalities across industries (macro approach) and then focusing on the specifics of the industry (micro approach). In my case, law enforcement taught me organizational skills, compliance skills, management skills, people skills, and ethical skills. When I later transitioned into health care management, these skills, along with some additional education, provided the needed qualifications to unlock my new career. Reflecting back, I truly believe that if you decide to explore a change in your particular career path, and you develop the knowledge, skills, and abilities through education, training, and experience, you can successfully jump across industries. I also believe that with a little hard work and determination, anyone can be successful.   

 

Tell us a little about your career path?

I began college and like many others, was unsure of what my career path was going to be. I initially chose to study law enforcement and became a member of the college police department.  I later enlisted in the US Army Military Police Corps, and became a criminal investigator. As such, I dealt with black marketeering, smuggling, mail fraud, customs violations, international counter narcotics and counter terrorism, theft, bribery, and human trafficking. During this time, I saw more of the negative side of people and decided that I wanted something different. This motivated me to explore and eventually find a new career path. When I was discharged from active duty, I continued service in the Army Reserves, enrolled in the business administration/pre-law program at a university and joined ROTC. My first job out of college was a Second Lieutenant in the US Army Medical Services Corps. I received a great deal of training and experience just by being willing to take on new tasks, accepting risk,  and saying yes to opportunities when presented. Subsequently I progressed from the Administrative Officer at a small clinic to the Chief, Ambulatory Support Branch at a hospital, then to the Executive Officer of 6 integrated (medical, dental and behavioral) health clinics, followed by assignment as Company Commander of a 200-bed Combat Support Hospital. As my military career continued to progress, I attended additional training that prepared me for assignments with the Deputy Chief of Staff for Resource Management at the Headquarters, Health Services Command. My last assignment was as Health Services Comptroller at Keller Army Community Hospital serving the United States Military Academy at West Point. During this period I also was chosen to be the Assistant Inspector General for Health Affairs, where I became very focused on regulations, compliance issues, audits, compliant resolution and answering congressional inquiries. 

 

After leaving military service, I used my network contacts to obtain a new role with Physician Corporation of America. There I progressed from an entry level Proposal Development Specialist working on a TRICARE proposal to Director of the Special Investigations Unit and later to Manager of Data Analytics and Reporting in the Information Technology department. Since that time I have steadily progressed in senior and executive operations management positions with several managed health care organizations including Comprehensive Care Corporation, Wellcare Health Plans, United Health, BeHealthy America, and Blue Cross Blue Shield of Arizona Advantage. Between full-time positions and in my spare time, I became a self-employed consultant in the managed healthcare industry. By working with a variety of managed medical and behavioral health plans, I have become a Subject Matter Expert in the areas of health care compliance, emergency preparedness planning, provider network development, and operations. In addition, my education and experience in law enforcement and health care has allowed me to become and remain a Certified Fraud Examiner for over 20 years. In this role, I chose to specialize in the development of Special Investigation Units in the health care industry, and participate in the detection, investigation and reporting incidents of suspected health care fraud, waste and abuse. Currently, I continue working in a variety of consultant roles and welcome new projects and opportunities.      

 

How have you continued to excel in your career for the past three decades?

The healthcare industry has significantly changed over my lengthy career and it has continued to interest me because I can use my whole toolbox to help make things better, faster, cheaper and smarter. I believe that my success continues to be driven by several key factors - I never stop learning, I accept challenges, and I don’t give up. Everybody excels at something, and most people tend to gravitate towards what they have aptitude and interest in. I have been fortunate that my interests, education, training and experience have evolved over time, my reputation in the health care industry has grown, and I’ve been adaptable to change. I always challenge myself and my colleagues to be the very best at what we do. Lastly, I always make time available to assist others.

 

If you had one piece of advice to share to those getting into compliance or transitioning to it what would it be? 

If I may, I have a few things I’d like to share. First, change is a constant. Be flexible and prepared to do the unexpected. Next, remember to leverage and expand your professional network. Evaluate and take advantage of each opportunity as it comes. Always lead by example and don’t be afraid of rolling up your sleeves. Finally, remember that expedience is the mother of all disaster. Why does it seem like there’s never enough time to do something right the first time, but there’s always time to do it over? Step back, take a breath, focus on the task and take the time necessary to produce a great outcome. 

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SunHawk Consulting

1475 West Oak St. #549
Zionsville, IN 46077

Tel. 317-775-3867