Is Oleck out at Region B? Time will tell

Sunday, October 23, 2005

WASHINGTON - As part of CMS's reorganization of the DMERCs, Region B Medical Director Dr. Adrian Oleck could be out of a job come next March.

Earlier this month, CMS awarded Region B's program integrity duties (fraud and abuse) - the job held by a region's medical director - to TriCenturion, which performs similar duties for Region A. Dr. Paul Hughes serves as medical director for TriCenturion, and in March, he will assume Oleck's job in Region B.

CMS decided earlier this year to reorganize the DMERCs into two components. One organization, the Medicare Affiliated Contractor or MAC, will handle a region's billing, customer service and other day-to-day operations. Each region will also have a Program Safeguard Contractor or PSC that handles fraud and abuse, medical review and crafts policy.

As part of the reorganization, CMS decided to combine the program oversight duties of Region A and B. CMS put the jobs out for bid last spring and awarded the contracts earlier this month. TriCenturion won the contracts for Regions A and B. EDI won the contact for Region D. The new Region D medical director is Dr. Mark Pilley. Former Region D Medical Director Dr. Robert Hoover left that job last summer.

The contract for Region C has not yet been awarded, and there's a chance Oleck could end up as that region's medical director. The current Region C medical director, Dr. Stacey Brennan, will reportedly be leaving that position for another job within Palmetto.

CMS has also solicited bids for companies interested in assuming the MAC duties and is scheduled to award the contracts in December. Most industry watchers expect the existing contractors -- Cigna (Region D), Palmetto GBA (Region C), HealthNow (Region A) and AdminaStar (Region B) - to retain those duties.