Gorman Health Group | Achieve Compliance
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non-compliance costs are too big to ignore

We offer guidance and support in every strategic and operational area in Government–sponsored health programs

Compliance is not a job function like enrollment or medical management. It’s an attitude. Compliance permeates every department, and must be supported by effective tools and rigorous oversight. Learn how we can help you create early warning systems to ensure that operational inefficiencies and threats to member satisfaction are identified immediately.

Delegation Oversight

In today’s regulatory environment, it’s critical that your PBM and other delegated entities perform flawlessly. With GHG’s in-depth delegation oversight assessments, our experts can help your organization learn where and how to verify potential issues and identify risk – empowering your teams to ask the tough questions.

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ANNUAL RISK ASSESSMENT

The annual risk assessment is an essential part of the ongoing risk management process that assigns priorities for mitigation plans. We can also help with the required annual audit and monitoring program. You’re busy with the crucial day-to-day duties. Let us conduct your required annual risk assessment – and put fire prevention within reach.

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Audits

The Centers for Medicare & Medicaid Services (CMS) audit practices have undergone a few changes in recent years, but the core focus remains the same: beneficiary protections. From a gap analysis to a comprehensive, deep-diving Part C and D audit, our team can help you minimize your compliance risk and maximize your time and resources.

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Marketing Material Review

Let’s face it: the marketing staff is at a disadvantage with the shortened period between bid submission and the start of the annual enrollment period. We can develop or review your sales collateral and creative by product type to help ensure your high-impact messaging is both targeted and compliant.

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Part D / Pharmacy

We can help your MA-PD or PDP develop and implement efficient and compliant internal operations and prepare effectively for CMS audits with professional services and unmatched compliance tools. Our broad array of services can assist you in post-audit remediation, implementation of best practices.

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Remediation

Through an internal auditing and monitoring process, the need for process improvements may have been identified and corrective actions put in place. How do you know if the right actions have been taken to remediate the issues found? Have measures been put in place to monitor and audit these items going forward to ensure sustainable correction? In addition to plans ferreting out their own internal deficiencies, you also have to be worried about getting “The Letter” from CMS. CMS conducts their audit, provides a list of risks and a short timeframe to correct the deficiencies. We can help.

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Application Support

The application process for Medicare Advantage and Part D, the Health Insurance Marketplace, and ACOs is an arduous one. Completing the application requires the cooperation from your entire organization. The actual submission leaves no room for error, and the review process requires quick thinking and prompt responses to CMS follow up questions. We’ve assisted scores of organizations through every step of the application process, from gathering the right data, completing the application, submitting, and responding to follow-up questions.

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Products

Our specialized software and applications solve problems not addressed by enterprise systems. Through our tools, gain the ability to onboard, credential, certify and monitor your sales force. Ensure your operational processes—and the resulting payments—are as accurate as possible. Meet the unique compliance needs of Medicare Advantage and Part D organizations. And choose the content you need from the robust curriculum developed by GHG industry experts.

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INTERIM MANAGEMENT

If you are looking for a seasoned veteran, GHG can enhance your team with our own, providing the leadership and knowledge your organization needs to keep moving forward. If it's just a question of bandwidth, we can supplement your departments with able professionals who have years of experience providing strategic, operational, financial, and clinical services to the industry, across a full spectrum of business needs.

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Health Policy Consulting

Gorman Health Group has partnered with TRP Health Policy, one of Washington, DC’s, most comprehensive, competent, and effective healthcare practices, to further deliver best-in-class health policy consulting services to our clients and their partners operating in Medicare, Medicaid, and the Health Insurance Marketplace.

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