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Timothy H. Gundlach, EMBA
Tim has more than 24 years of experience in the healthcare industry, working with health plans in commercial and Medicare lines of business. He has expertise in MAPD compliance and investigations, governmental programs operations, and fraud, waste, and abuse (FWA) initiatives. Tim has participated in and managed audits of MAPD Plans for CMS. He has also led complex compliance remediation and development strategies for major national health plans, with a strong focus on special investigations, FWA, and compliance training.
Experience
- Significant experience, including senior leadership, with MAPD plans, program integrity, regulatory compliance, and project management
- As corporate and financial investigations department lead, identified $2.1 million in contract liability risk and developed a fraud awareness employee training program, which resulted in a 20% increase in case referrals
- Served as interim Medicare compliance officer for MAPD plan, led Medicare compliance program and PBM operations, and chaired compliance committee reporting to CEO
- Worked with plans new to Medicare to apply for CMS approval and go live with fully compliant policies and procedures
- Coordinated and conducted compliance plan effectiveness audits and operational assessments
Qualifications
- 24+ years' healthcare experience
Education
- Executive Master of Business Administration, LeBow College of Business, Drexel University
- Master of Science in Health Services Administration, University of Saint Francis
