Meet Pamela A. Cleveland: If it's not in writing, it didn't happen

AT: Thanks for taking the time to talk to me. It was good meeting you at the HCCA Managed Care Compliance Conference. In this interview, I hope we can explore your career, some of your outside interests, and also some of the challenges in managed care. Let’s go back to the beginning of your compliance career. In 2005, you got into compliance after having operated as outside counsel for some time. What led you into the field?

PC: I tell people that I think compliance chose me versus me choosing compliance. I was drawn to compliance based on my type A personality and attention to detail. I have always been a rule follower and enjoy anywhere where I can partner in helping others to do the same. Kaiser Permanente recruited me to implement Medicare Part D in the Ohio area.

AT: You began your career at Kaiser, which is famous for the fact that everything is under one roof. Does that create any special compliance considerations, or have you found that it’s pretty similar to what other organizations face?

PC: Integrated Health Systems come with their own challenges for the healthcare compliance industry, especially when it comes to privacy and security. The all-under-one-roof model comes with separation of healthcare versus health insurance challenges. I have encountered concerns when patients would like to keep their information private from their insurance membership or when insurers would like to use patient information for administrative purposes. There are also concerns when sharing or analyzing data in an integrated system where fraud, waste, and abuse (FWA) are concerned. It creates a unique dynamic when an employed physician comes up as a data outlier FWA alerts.

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