Team Peak Performers: CCHP Regulatory Compliance Team

As many other areas have experienced, our small compliance department experienced a reduction in staff that impacted some very risky functions within our department. These areas included our fraud, waste and abuse investigations, which includes responding to almost daily requests from the Office of Inspector General (OIG), as well as oversight audits of our delegated entities, pharmacy lock-in program activities and other contractual responsibilities. With our state contracts being very punitive, it was vital that we continued to perform these functions in compliance with our state contracts even though we were missing several key staff members. This also happened at a time when we were going through a readiness review by Texas Human and Health Care Services (HHCS), implementing a fraud, waste and abuse (FWA) analytic tool in order to insource the FWA investigatory process and in the middle of our annual delegated entity audits. The regulatory compliance team stepped in, without being asked, and took on added job duties that were not their responsibility and helped us keep our department functioning. 

I would love to give a special call out to Rocio Whipplemendoza and Pamela Richardson. Rocio had recently come to us to help with our administrative responsibilities regarding our FWA investigations. When our investigations manager left, Rocio took on the responsibility of responding to all of the OIG requests. These requests must be responded to within 24 hours. This was way beyond her job duties but she took it upon herself to learn the process, take that task on and did an amazing job at that. Pamela was one of the FWA Analysts promoted into another area within Compliance but she not only learned how to do her new job, but she also kept on doing a part of her old job in FWA, again, without being asked. I am so thankful for what they did to help our team.

All the other team members stepped in and helped me and their manager, Darwyn Walker, by taking on other tasks so that Darwyn and I could concentrate on conducting the annual delegate audits and other vacated responsibilities. Darwyn not only had his normal tasks to do but he also took on responsibility for one of our monthly committee meetings by preparing all of the trend reports and the slide deck for that meeting each month while also training the replacement person at the same time. During this time, our department was also given the additional responsibility of Cook Children’s Health Plan Staff Education. That role came to us with two positions and one of them was already vacant and the one individual that transferred to us had already accepted another position elsewhere. Darwyn had to immediately work to learn this function and get two new educators on board. He successfully completed this with only having to reschedule one round of new employee orientation which allowed us to remain in compliance with our regulatory requirements.