Dr. Cornelia M. Dorfschmid has over 25 years of private and government sector experience in health care compliance consulting, the majority of which was in management and executive capacities. She is a recognized expert in the areas of claims auditing, overpayment analysis and risk management and corporate health care compliance. She provides senior advisory services on compliance risk assessments, enterprise risk management, RAT-STATS sampling and overpayment estimation, and litigation consulting.
She is experienced in board compliance oversight duties and served as a Board Audit and Compliance committee member for a hospital system and a health plan. She also has operational and Independent Review Organization or Compliance Expert experience with organizations under CIA and settlement agreements with the Department of Health and Human Services Office of Inspector General. She leads the firm’s IRO efforts and works with IRO clients on claims and arrangements reviews. She also supports various law firms and their clients in arriving at satisfactory solutions to payment error issues, overpayment settlements, fair market value issues, and self-disclosure.
Dr. Dorfschmid specializes in providing senior advisory services in “turn around” situations to health care organizations ranging from hospital systems, group practice networks to managed care, disease management, clinical laboratory and DME organizations. Her advisory services cover such areas as compliance program (CP) development and implementation, CP effectiveness assessments, including enterprise risk management, litigation and self-disclosure support (SDP) and resolution, RAT-STATS sampling and estimation of overpayments related to Medicare, Medicaid and private payers.
Earlier in her career, as VP for Surveys & Evaluations for the firm she developed survey instruments and health care compliance indices (HCCI™, Compliance Benchmark Survey™, Compliance Monitor™) and various compliance assessment and risk assessment protocols. As Senior VP & CIO for the firm, she was instrumental to the development of training software tools (HIPAABASICS.net, ComplianceSAVER™, CPBasics™, CPEssentials™, In her past capacity as CIO of the firm, she oversaw the firm’s technology efforts to advance compliance through technical tools and offerings, and designed and managed FACIS®, a web-based data search service on disciplinary actions that continues to operate as an independent company, as well as the Compliance Interactive Tutorial System™ (CITS™ for the AMA). She has served as Interim or Designated Compliance Officer for health care organizations. She is particularly experienced in compliance risk management, including internal control reviews and revenue cycle risk analysis and oversight. She is a frequent speaker and has presented at various associations and professional organizations and events and published on such issues as Risk Management and Methodologies, Compliance Risk Areas, Benchmarking Compliance Program Effectiveness, Claims Auditing and Monitoring, Overpayment Estimation, and HIPAA Privacy and Security.
Dr Dorfschmid regularly presents at industry conferences and events publishes in on various compliance topics.
Previous Work Experience
Prior to joining Strategic Management Systems, Inc. and Strategic Management Services, LLC, Dr. Dorfschmid was a full time research and teaching staff member and involved in competition policy and antitrust/cartel law issues at the Institute for Economic Research Policy Division at Albert-Ludwigs-University at in Freiburg, Germany (Institut for Allgemeine Wirtschaftsforschung – Abteilung Politik), where she taught economics courses and labs at the graduate level and oversaw student master’s thesis work. Subsequently, as an adjunct professor in the Economics Department of New York University (NYU), she developed class curriculum and taught macroeconomics, statistics, and econometrics for the Department of Economics at New York University. She later worked as a statistical consultant to investment firm Morgan Grenfell, Finance where she used her expertise in applied economics and econometric models of financial instruments and participated in bond option portfolio pricing projects by estimating bond option portfolio volatilities using time series analysis with the statistical software package RATS (Regression Analysis of Time Series).