Karen Eastmond, MBA, CHC, CHPC
About
Karen Eastmond, MBA, CHC, CHPC, is an experienced leader with an extensive history of working in healthcare compliance, healthcare management, and business process improvement. Her journey in healthcare began in government programs, later transitioning into a New York health system, where she gained invaluable insight into the intricate interplay between regulatory requirements, operational efficiency, and patient care. Her roles in managed care also provided insight into the dynamic landscape of payer-provider relationships, reimbursement models, and quality assurance protocols.
Ms. Eastmond has also served as a consultant to a diverse range of clients, including hospitals, home care agencies, physician practices, and private equity firms. In these capacities, she has provided strategic guidance, conducted thorough compliance assessments, and developed tailored solutions to address the unique needs and challenges of each client.
Ms. Eastmond has been a guest speaker at the Health Care Compliance Association (HCCA) Compliance Institute, where she has shared her insights and expertise on successfully resolving a multi-year OCR investigation with fellow industry professionals and thought leaders.
Experience
- Implemented system-wide compliance program including Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs), Article 28 clinics and managed care.
- Built and directed a system-wide compliance and risk management program spanning Home Health Agencies (HHAs), Skilled Nursing Facilities (SNFs), and long-term care lines of business, including policy redesign and corrective action planning.
- Oversaw regulatory compliance for long term care programs, translating evolving CMS and state requirements into implementation plans and corrective action strategies for long-term care and home-based populations.
- Led the annual risk assessment process for home health and long-term care operations, driving audit-response corrective action plans and reporting compliance status to the CEO, Audit & Compliance Committee, and Board of Directors.
- Redesigned Compliance Program including policies and procedures for compliance with federal and state regulations, Medicare Advantage, PACE and the Code of Conduct
- Implemented the annual risk assessment process to identify key business risks and lead the development of annual work plans, risk mitigation plans and CAP implementation.
- Collaborated with business leads to address the resolution of critical operational issues impacting the business.
- Successfully developed systems for oversight, tracking and monitoring of regulatory developments for Medicare Advantage I-SNP, MLTC, FIDA and PACE and Part D.
- Fostered productive engagements with representatives of federal and state regulatory and enforcement agencies to ensure effective communication and cooperation.
- Developed business plans for Medicare including operational goals, performance targets, compliance targets, and implementation of new CMS guidelines.
- Developed and recommended annual compliance and internal audit program work plans and report findings and recommendations to COO, CEO and Board of Directors. Chair Compliance Committee.
Areas of Expertise
- Compliance Programs
- Compliance Services
- Cybersecurity
- HIPAA Compliance
- Mergers & Acquisitions Compliance Services
- Regulatory Compliance
Education
Baruch College/Mt. Sinai School Of Medicine
Executive MBA, Health Care Administration
New York, NY
Brooklyn College
Bachelor of Science, Business, Management & Finance
Brooklyn, NY
Certifications
Certified in Healthcare Compliance (CHC)
Certified in Healthcare Privacy Compliance (CHPC)
Professional Memberships
Healthcare Compliance Association (HCCA)
