Informative Interview

COMPLIANCE, QA,& PERFORMANCE IMPROVEMENT

Reducing Risks. Improving Growth. 

Often times our clients have everything they need to succeed, they just require the resources and support to make a strategic jump. Amaka Consulting helps clients to identify unique compliance, QA/QI, and regulatory risks associated with a varied mix of programs, program activities, quality outcome components, and continuous performance improvement operations.

 

COMPLIANCE &

PERFORMANCE IMPROVEMENT 

Project #1: NEW RULES/REGULATION DEFINITION & IMPLEMENTATION

1. ISSUE

New Rules Definition and Implementation; Analysis of complex regulatory, guidance, and best-practice information and project/business requirements into consumable and actionable information for use by staff, managers, directors, and senior leadership.

2. CHALLENGES

The Jewish Board Mishkon Division was “encouraged” by regulators to augment their Regulatory Compliance and Quality Assurance capabilities following an external Federal audit.

3. RESULT

Using industry knowledge and experience, Amaka Consulting defined a recommended set of new rules for the agency's program that was coded into the management and service delivery systems.


Worked closely with the Jewish Board Mishkon senior leadership to present the proposed changes to the utilization review department for validation, prior to implementation.


Amaka Consulting managed the process of development, testing, and deployment of the new rules.

4. CONTACT / VERIFICATION

Esther Gottlieb

Director of Performance Improvement

Mishkon Division

Jewish Board of Family & Children Services (JBFCS)

1358 56th St,

Brooklyn, NY 11219

+1(718) 851-7100

esgotlieb@jbfcs.org 

 

Project #2: INTERNAL REVIEW, RECORD RETENTION, & PREVENTION AND DETECTION SYSTEM

1. ISSUE

Internal Review, Record Retention, Prevention, and Detection Platforms/Systems;

Lead tools development and/or revisions, develop and oversee data flow cycle;


Oversee and direct implementation of corrective and performance improvement actions; and report compliance activities and audit/review findings to the Board.

2. CHALLENGES

JBFCS provides over 15 services and has to deal with 6 different state & federal regulatory bodies. The agency needed a uniformed Code of Conduct, an integrated policy & procedure, and records management.

3. RESULT

Augmented existing internal policy & procedure to meet regulatory requirements.


Helped strengthen the organization's compliance and quality assurance, and performance improvement management.


Led the creation of a system that enhanced:

  • Standards and Procedures.

  • Verification of Compliance and Evaluation of Effectiveness.

  • Consistent Promotion of and Enforcement of compliance.

  • Implementation of a system to make and track response to and remediation of non-compliance.

  • Helped revised and synchronized the code of conducts.

4. CONTACT / VERIFICATION

Esther Gottlieb

Director of Performance Improvement

Mishkon Division

Jewish Board of Family & Children Services (JBFCS)

1358 56th St,

Brooklyn, NY 11219

+1(718) 851-7100

esgotlieb@jbfcs.org 

 

Project #3: FRAUD, WASTE & ABUSE PREVENTION & RISK MANAGEMENT SYSTEM

1. ISSUE

Fraud, Waste, & Abuse Investigation; and development of a preventive Risk and Management System to improve internal controls, and deter and detect fraud.   


A system of deterrence and detection of fraud, waste, and abuse in the agency by examining and evaluating the adequacy and the effectiveness of the agency's systems of internal control, commensurate with the extent of the potential risk in the various segments of the organization. 

2. CHALLENGES

With over 2000 employees and 75 different program locations, lost, misuse, waste, and billing frauds were an existential challenge for the Jewish Board

3. RESULT

  • Helped set up an organization-wide reporting system about how contracted physicians, social workers, other healthcare providers, and business partners can help with fraud, waste, and abuse detection, correction, & prevention.


  •  Set up two online self-paced training for both Fraud, Waste, and Abuse and a General Compliance Training.


  •  Made reporting suspected violations easier by use of a hotline and allowing for anonymous reporting.


  •  Modified and sufficiently communicated the non-retaliation policy for "good faith" reporting.


  •  Trained staff on prevailing federal, state,  and agency policy and procedure around fraud and reporting standards.


  • Investigated fraud, waste, and abuse incidents and developed recommendations to strengthen internal control.


  • Implemented capacity development training of selected staff to carry out investigation responsibilities. 

4. CONTACT / VERIFICATION

Jennifer Kindle-Sheppard

Director of Compliance

Jewish Board of Family & Children Services (JBFCS)

135 W 50th St, New York, NY 10020

+1 (212) 582-9100

jkindle@jbfcs.org