2022 HCCA Managed Care Recap by Kimulet Winzer

Kimulet Winzer, Director at SunHawk Consulting, attended and presented at the 2022 HCCA Managed Care Conference. See the article below to read her recap of the 2022 HCCA Managed Care Conference in Phoenix, Arizona!


Day One: Diversity, Equity and Inclusion in the Compliance Space

Sunday’s preconference sessions began with Cheyenne Ross and my presentation on Diversity, Equity, and Inclusion in the Compliance Space – a session centered on building professional relationships on a foundation of trust, stepping out of your comfort zone, and intentionally seeking out and conversing with individuals who aren’t like you. During our presentation, we asked our audience to consider the following:

1. Does what you are currently doing work for you now and into the future?

People can be heard saying things will soon “return to normal,” but what is ahead is not the same, comfortable 2019 routine. People now feel more strongly about wanting to be respected, accepted, and safe in their work environments, and compliance will undoubtedly be viewed with a new perspective.

2. We must include those we have often seen as holding the power and purse to the table to help create a space for everyone.

We cannot talk about an inclusive environment while also seeking to exclude those we find at fault. Ensuring that your compliance committee represents all voices in your organization is a great place to start.

Day Two: Managed Care: OIG Update on Priorities and Risk Areas in Managed Care

Day two of the conference was kicked off by Megan Tinker, Assistant Inspector General, who shared her insights on upcoming OIG work and priorities in managed care. In her presentation, Ms. Tinker reiterated the importance of reading the audit reports issues by OIG, as well as provided some additional tips to the audience:

1. Establish an escalation protocol when developing programs

2. Understand your company’s data. Where does it come from? How reliable is it? Is there a consistent set of standard rules and what happens when there is an anomaly?

It is crucial that business leaders, in addition to compliance staff, read the audit reports and presentations published by OIG to ensure that all relevant decision-makers within your organization are on the same page. Unfortunately, business leaders rarely have the bandwidth to digest this information, and it is unlikely that compliance professionals have the time to routinely check the OIG website for audit information.

To remedy this issue, SunHawk Consulting, LLC has developed reports to summarize OIG’s work plan and completed audits, which can be viewed HERE. If, as a compliance professional, you are looking to expand your education and training offerings, what better way than providing relevant excerpts from actual audits to help sensitize your board and business leaders to the importance of audit preparations, risk assessments, and timely and accurate data within organization systems?

Day Three: Why Me? Compliance Officer’s Personal Risks in Managed Care Investigations: Liaison, Witness, Subject, Defendant, Whistleblower

Jim Sheehan’s presentation provided his audience with some fantastic insights, and it was apparent that he genuinely wanted to engage with compliance professionals to improve the various healthcare systems we work within.

My big takeaway from Jim’s presentation:

We should be focused on the growth that is occurring within third-party oversight to provide appropriate education and training of third-party staff and ensure they have the resources, experience, and budget to do the job.

Additionally, ensuring that we communicate and integrate our third parties into a well-designed compliance program that is “operating, earnestly and in good faith” goes beyond writing terms in contracts and telling them that they should adhere to policies that are never shared. Some questions to ask yourself:

1. Do you know who the compliance point of contact is for the third-party vendors your organization works with?

2. Do you understand how your vendors’ compliance program works?

3. How often do you share updates and regulatory changes that impact your program and business with your vendors?


About the Speaker

Kimulet Winzer


SunHawk Consulting, LLC

Kimulet Winzer has 25 years of Medicaid managed care experience. She’s worked with healthcare providers, advocates, regulators, payor plans, attorneys, vendors, lobbyists and healthcare leaders on a myriad of operational remediation's, innovations and core compliance program development, implementations and training. Most recently she served in a leadership role with UnitedHealthcare as a regional compliance director for the Medicaid program. Prior to her 13 years with UnitedHealthcare she helped to build and implement Medicaid and Medicare DSNP Compliance programs; oversee member and provider grievance and appeal processes and help in the understanding of regulatory changes impacting the delivery of managed Medicaid services and programs.