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CMS Leadership

Program Integrity Group

Kim Brandt, Director

Lisa Zone, Deputy Director

Western Program Integrity Los Angeles Staff - Don Kennedy, Director
Southeastern Program Integrity Miami-Dade Staff - Cecilia Franco, Director
Northeastern Program Integrity New York Staff - Jean Stone, Director
Division of Provider/Supplier Enrollment - Jim Bossenmeyer, Director
Division of Medical Review and Education - Sandra Bastinelli, Director
Division of MMA Integrity - Vacant
Division of Analysis & Evaluation - Doug Nock, Director
Division of Benefit Integrity Management Operations - Brenda Thew, Director

Functional Statement

  • Develops Medicare and Medicaid program integrity strategy and tactics for fee-for-service and managed care financing.
  • Manages all facets of program integrity functions for both current Intermediaries and Carriers and Medicare Integrity Program contractors.
  • Serves as CMS' point of contact for program integrity issues.
  • Manages all Medicare program integrity enforcement activities.
  • Assures that all benefit payments are correct.
  • Identifies and monitors program vulnerabilities and affect change as necessary.
  • Coordinates with CMM and OCSQ in the development of contractor medical review policy.
  • Develops and implements requirements for provider/supplier enrollment in the Medicare program and assures the safeguard of program payments through effective enrollment processes and procedures.
  • Works with the HHS Office of Inspector General to levy civil money penalties against plans that commit or participate in fraudulent or abusive activities affecting the Medicare program, including submission of fraudulent data.
  • Works closely with, and serves as liaison to the US Department of Justice and other state law enforcement agencies in developing cases against plans committing or participating in fraudulent or other unlawful activities.
  • Works with Centers and Offices across the Agency to identify and monitor program vulnerabilities and effect changes in policy as necessary.
  • Serves as primary Agency focal point for fraud, waste and abuse oversight of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) provisions related to the drug card, drug benefit, and the Medicare Advantage program.
  • Serves as the primary Agency focal point for detection and deterrence of all fraud and abuse related activities in the Los Angeles area.
  • Serves as primary Agency focal point for functional administration and oversight of Medicare Program Safeguard Contractors.

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Page Last Modified: 07/25/2008 2:24:00 PM
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