Years of professional compliance experience
TONYA HORTON
NJ/NY
Summary
Highly motivated and result-oriented legal professional with years of experience managing compliance and privacy functions in the highly regulated healthcare industry. Known for identifying areas of risk within the organization and developing plans to mitigate those risks while auditing, monitoring, and investigating healthcare operations. Highly knowledgeable in healthcare laws and regulations. Excellent managerial and interpersonal skills with the ability to effectively communicate at all organizational levels.
Overview
15
15
3
3
Certification
Work History
Director, Corporate Compliance, Privacy & Institutional Review Board
Atlantic Health System
09.2012 - Current
- DESIGNED comprehensive corporate compliance program for healthcare system which includes five hospitals, 400+ physician practices, ambulance, pharmacy, clinical research trials, durable medical equipment, hospice and home care divisions with over 20,000 employees
- DETERMINE risks and non-compliance areas through execution of extensive risk-based monitoring plan and compliance assessments with legal services and Health Information Management group while defining corporate compliance policies as per state and federal laws
- CONDUCTED risk assessments and internal audits ensuring continuous improvement and maturity of compliance program
- COORDINATE internal assessment of compliance with laws and regulations with focus on OIG guidance and Federal Sentencing guidelines
- MANAGED oversight of internal compliance hotline, ensuring adherence to established protocols
- IMPLEMENTED procedures to streamline investigation and resolution process for calls received via compliance hotline, enhancing efficiency and accuracy in addressing reported issues
- PROMOTE employee's conformance with applicable federal and state laws, update appropriate managers on potential compliance-related problems and provide consultation on external requirements based on current understanding of regulatory trends and change in law
- COMPILE detailed compliance reports for Office of Inspector General in line with Corporate Integrity Agreement and provide guidance on government pricing including federal contracting requirements, Medicaid, Medicare Part B, Medicare Part D, and 340B pricing
- REVIEW compliance findings during meetings with Board of Trustees and senior leadership to develop corrective action plans, guide management staff in trends affecting their operation, enforce HIPAA standards and plan training/education programs.
- DEVELOPED high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
- ENHANCED team collaboration through regular communication, goal setting, and performance evaluations.
- WORKED closely with organizational leadership to guide operational strategy.
General Counsel
Compassionate Care Hospice
11.2008 - 08.2012
- FACILITATED seamless resolution of complex state and federal healthcare regulatory issues related to federal anti-kickback compliance, stark law compliance, Medicare/Medicaid, anti-corruption laws, and HIPAA compliance
- ADVISED executive leadership on strategic decisions, minimizing legal risks and ensuring positive outcomes.
- MANAGED litigation strategy to successfully resolve high-stakes disputes with minimal financial impact.
- MET tight deadlines and effectively managed multiple priorities using strong organizational skills.
- COLLABORATED with cross-functional teams to establish best practices for managing contractual obligations.
- MITIGATED employment-related risks by crafting clear policies addressing workplace conduct and performance expectations.
- SUCCESSFULLY resolved numerous disputes through skillful mediation, preventing costly litigation and preserving business relationships.
- ADMINISTERED licensing, trademark and transactional matters along with real estate transactions, rentals and leases for 58 locations in 21 states.
- NEGOTIATED national pharmacy and durable medical equipment contracts
- PRESENTED high-quality legal guidance and support on regulatory and compliance related matters, led due diligence in all mergers and acquisition transactions, secured medical equipment and negotiated service agreements
- MET state and CMS guidelines by reviewing physician and staff employment contracts in addition to overseeing care contracts and non-compete agreements
- ADDRESSED risk assessment, HR and daily operational issues while supervising corporate governance functions and counseling on Medicare, Medicaid, government reimbursement and regulatory matters.
Education
J.D. - Law
Seton Hall University School of Law
Newark, NJBachelor of Arts - Political Economy
Princeton University
Princeton, NJSkills
- Privacy Compliance
- Regulatory & Legal Standards
- Documentation & Reporting
- Complex Issue Resolution
- Project Management
- Stark, AKS, GCP, GDPR, HIPAA
- Board Reporting
- Compliance Training & Education
- Risk Assessment/Management
- Multidisciplinary Collaboration
- People Management
- Operations Management
Certification
- Certified in Healthcare Compliance- CHC
- Certified in Healthcare Privacy Compliance- CHPC
- Certified in Healthcare Research Compliance- CHRC
- Licensed NY State Bar
- Licensed NJ State Bar
Quote
There are no secrets to success. It is the result of preparation, hard work, and learning from failure.
Colin Powell
Timeline
Director, Corporate Compliance, Privacy & Institutional Review Board
Atlantic Health System
09.2012 - Current
General Counsel
Compassionate Care Hospice
11.2008 - 08.2012
J.D. - Law
Seton Hall University School of Law
Bachelor of Arts - Political Economy
Princeton University
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