Rise

RISE National 2024 proudly welcomed the Office of Inspector General (OIG), the Centers for Medicare and Medicaid Services (CMS), and the Department of Justice (DOJ) to the agenda for keynote addresses, as well as a panel of OIG experts for a deep dive session on 2024 priorities. Each year, we welcome government agencies to the stage for essential regulatory updates and to get your most pressing questions answered related to the Advance Notice.

Christi A. Grimm
Inspector General
Office of Inspector General
Department of Health and Human Services

By popular demand, we welcome Christi A. Grimm back to RISE National for the second year in a row to provide an informative keynote address answering your most pressing questions about the changes from the CMS Final Rule and the evolving Medicare Advantage landscape.

Christopher Bresette 
Director of Medicare Part C Audits, Office of Audit Services
U.S. Department of Health and Human Services – Office of Inspector General 

 

Christopher G. Bresette is the Director of Medicare Part C Audits with the United States Department of Health and Human Services (HHS), Office of Inspector General, Office of Audit Services.  Mr. Bresette is responsible for the implementation and coordination of all audits of the Medicare Advantage program.  Based on more than 30 years of experience, he provides expert advice to other auditors about the design and execution of those audits.  In addition, Mr. Bresette has a wealth of knowledge regarding other HHS programs, including traditional Medicare and Medicaid, and has conducted several audits designed to detect and prevent fraud, waste, and abuse.  Mr. Bresette also provides training to new and experienced auditors about the Medicare Advantage program.  Mr. Bresette graduated with honors from Rockhurst University with a BSBA in Accounting and is a certified public accountant, licensed in Missouri.  Mr. Bresette has received numerous exceptional achievement awards and was previously bestowed with one of the agency’s highest honors when he received the Inspector General’s Bronze Award for the outstanding auditor of the year.

 

Alexis Mills
Social Science Research Analyst, New York Regional Office
U.S. Department of Health and Human Services – Office of Inspector General 

 

Alexis Mills is a Social Science Research Analyst in the New York regional office of the Office of Evaluation and Inspections within the U.S. Department of Health and Human Service’s Office of Inspector General. Alexis’ research areas of expertise include Medicare Fee-for-Service, Medicare Advantage, telehealth, remote patient monitoring, and T-MSIS. Alexis received a Master of Science in Social Work from Columbia University.

 

Isaac M. Bledsoe
Special Agent, Operations Officer
U.S. Department of Health and Human Services – Office of Investigations Office of Inspector General 

 

Isaac Bledsoe is a Special Agent with HHS-OIG and currently serves as an Operations Officer within the Investigations Branch at OIG’s Headquarters.  His duties and responsibilities include oversight into various programmatic areas including DoJ’s Strike Force Operations, Medicare Part C, and the Office of Refugee Resettlement.  His work prior to coming to OIG’s Headquarters included conducting complex investigations involving violations of criminal, civil and administrative law regarding HHS funds and beneficiaries (specifically in the areas of genetic testing, telemedicine, DME, home health, managed care and COVID-19 related pandemic frauds).  He previously served as a Special Agent with the United States Air Force Office of Special Investigations (AFOSI) and was a Officer in the United States Air Force.  SA Bledsoe holds a Bachelor of Science Degree in Criminology and Criminal Justice from the Florida State University and a Master’s Degree in Family, Youth & Community Sciences from the University of Florida.

 

Carolyn Kapustij
Senior Advisor for Managed Care, Office of Audit Services
U.S. Department of Health and Human Services – Office of Inspector General 

 

Carolyn Kapustij serves as a Senior Advisor for Managed Care at the Office of Inspector General (OIG) for the Department of Health and Human Services.  At OIG, she develops and leads enterprise-wide strategies to oversee Medicare Advantage and Medicaid Managed Care programs.  She previously worked at the Centers for Medicare and Medicaid Services (CMS) and oversaw the improper payment measures for Medicare Part C and Part D, developed program integrity activities for the Federally Facilitated Exchanges, and developed payment policy for MA and Medicare Part D plans. She holds a Master of Public Health from the University of Michigan.

 

Allison Wiley
Health Insurance Specialist
Center for Consumer Information and Insurance Oversight
Centers for Medicare & Medicaid Services (CMS)

 

Allison Wiley is the Director of the Division of Policy and Analysis for the Payment Policy and Financial Management Group in the Center for the Consumer and Insurance Oversight (CCIIO) in the Centers for Medicare and Medicaid Services (CMS).  Her team is responsible for the policies associated with the financial management programs established in the Affordable Care Act, as well as parts of the No Surprises Act. Her team’s work includes the policies governing the HHS-operated risk adjustment program and HHS-operated risk adjustment data validation.  In her previous role, she served as the technical policy lead for HHS-operated risk adjustment program and HHS-operated risk adjustment data validation and has previously served as a subject matter expert on the essential health benefits and actuarial value.

Daphne Letherer
Management & Program Analyst
Center for Consumer Information and Insurance Oversight
Centers for Medicare & Medicaid Services (CMS)

 

Daphne Letherer is a subject matter expert in the Division of Risk Adjustment Operations for the Payment Policy and Financial Management Group in the Center for Consumer and Insurance Oversight (CCIIO) in the Centers for Medicare & Medicaid Services (CMS). Daphne’s work focuses on the operations of HHS-operated risk adjustment data validation in the Affordable Care Act markets, and her team leads the technical assistance and outreach efforts for participants of HHS-operated risk adjustment data validation.

 

Edward Crooke
Assistant Director in the Civil Fraud Section
U.S. Department of Justice

 

Edward Crooke is an Assistant Director in the Civil Fraud Section of the U.S. Department of Justice. Mr. Crooke has represented the Department in a range of healthcare fraud matters involving Medicare Advantage plans, electronic health record vendors, pharmaceutical and device manufacturers, hospitals, clinics, and physician practices. He also advises the Department and coordinates efforts with other federal agencies regarding healthcare fraud issues. The Attorney General has twice recognized Mr. Crooke’s performance with the John Marshall Award and the Award for Fraud Prevention. Mr. Crooke joined the Department in 2007 following a federal clerkship in the District of Maryland and several years in private practice. Mr. Crooke is a graduate of Haverford College and the University of Virginia School of Law.