Overview

Machelle Shields is a Strategic Advisor for EBG Advisors, Inc. She has more than 20 years of experience in all aspects of compliance and ethics, privacy (HIPAA), and reimbursement support and strategy.

Specifically, Machelle:

  • Provides compliance and regulatory services to life science companies, including device/technology reimbursement strategy (coding, coverage, and payment)
  • Advises on the infrastructure needs of start-up device companies and all aspects of compliance program design, operation, and implementation across the entire health care spectrum—physicians, hospitals, Medicare Advantage, device and pharmaceutical companies, and other health care providers
  • Develops and implements fraud and abuse compliance programs for all areas of health care
  • Performs monitoring and oversight for DPAs, CIAs, and corrective action plans
  • Provides HIPAA/HITECH privacy, security, and compliance program implementation and support services
  • Conducts compliance program assessments and Medicare/Medicaid readiness assessments
  • Conducts compliance and privacy/security gap analyses and risk analyses
  • Handles all aspects of monitoring, auditing, compliance diligence, and internal investigations
  • Provides contract support services with a focus on compliance, regulatory, and federal and state privacy laws
  • Advises on health care administration and compliance and academic medicine
  • Drafts OIG advisory opinions

Focus Areas

Experience

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  • Developed a defensible coding/extrapolation strategy that reduced a $3.6 million recoupment to $86,000.
  • Served as a federal monitor team lead for 18 months for a device company’s deferred prosecution agreement.
  • Served as a monitor for an Office of Civil Rights’ HIPAA Corrective Action Plan with a large academic medical center (for three years).
  • Serves as an oversight organization monitor for a company under a deferred prosecution agreement.
  • Serves as Chief Compliance Officer for multiple entities.
  • Conducted compliance diligence as part of a $3.9 billion acquisition.
  • Handled compliance preparation for a multistate hospice.
  • Developed and implemented a corrective action plan for an academic medical center in a 340B audit that was conducted by the Health Resource & Services Administration and included the manufacturer repayment process.
  • Developed a corrective action plan for a hospital with alleged violations of the Emergency Medical Transport and Active Labor Act (EMTALA), and imposed the “immediate jeopardy” process by the Centers for Medicare & Medicaid Services.
  • Managed a medical practice with clinical- and academic-based physicians, which included serving as a billing compliance committee member for a 400+ physician faculty medical group and handling fraud/abuse and privacy issues and compliance plan development, implementation, and monitoring.
  • Developed a new medical faculty department specifically targeted as the primary care entrance for a 110,000-square-foot multi-specialty center, including handling departmental integration and centralized organization of staffing models, competency models, budgets, billing compliance, protocols (clinical and administrative), procedures, governance, patient flow, cost-benefit analyses, and pro formas.
  • Oversaw human resource development, departmental policy and maintenance procedures, CLIA certification, and compliance with OSHA and Accreditation Association for Ambulatory Health Care (AAAHC) regulations.

Credentials

Media

Events

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Insights

Certifications

  • Certified in Healthcare Research Compliance (CHRC), HCCA
  • Certified Coding Specialist – Physician (CCS-P), AHIMA
  • Certified Medical Practice Executive (CMPE), MGMA
  • Certified Professional Coder (CPC), AAPC
  • Certified Professional Coder – Hospital (CPC-H), AAPC
  • Certified in Healthcare Compliance (CHC), HCCA
  • Certified in Healthcare Privacy Compliance (CHPC), HCCA
  • EMT-IV Technical Certificate
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