Keith is the partner-in-charge of the firm’s Raleigh, North Carolina office and he is a co-partner in charge of the managed care engagement team. He has nearly two decades of health care audit and consulting experience, specializing in compliance auditing for health care programs, with an emphasis on Medicare and Medicaid regulation compliance and reimbursement issues.
From 2005 to 2009, and from 2013 to the present, Keith managed our contract with the North Carolina Department of Health and Human Services (DHHS). In this capacity, he has provided management oversight annually, for more than 50 long-term care (LTC) facility audits, 80 hospital audits, and provided technical assistance to DHHS related to provider audit protocols, provider appeals, and mediation hearings. Prior to working with our DHHS client, he spent five years performing desk reviews and field audits of Maryland Medicaid cost reports.
Since 2009, Keith has managed audits overseeing the Medicare Part C and D programs for the Centers for Medicare & Medicaid Services (CMS). His Part C and D experience includes managing financial examinations of Medicare Advantage Organizations and Prescription Drug Plans (MAO/PDPs), reviews under the Medicare Drug Integrity Contractor (MEDIC) program, and compliance and performance audits of MAO/PDPs. In addition, he has conducted presentations on the Part C and D payment processes for CMS and law enforcement agencies.
Since 2017, Keith has managed a consulting engagement with the Illinois Department of Health and Family Services (DHFS) which involves validating the outstanding provider liabilities on the books of the 12 managed care organizations (MCOs) administering benefits for the Department.
Keith is a Certified Public Accountant (CPA) and a Certified Fraud Examiner (CFE). He is a member of the American Institute of Certified Public Accountants, the Association of Certified Fraud Examiners, and the North Carolina Society of Certified Public Accountants.
NC CPA Lic. 31544
MD CPA Lic. 32483
Education
B.A., Accounting
University of Pittsburgh
Specialties
- Health care auditing and consulting services, with an emphasis on Medicaid cost reporting by long-term care and hospital providers.
- Financial examinations and performance/compliance audits of Medicare Advantage Organizations and Prescription Drug Plans.
- Performance audits of third-party administration of health and drug benefit plans.
- Consulting services related to Medicaid managed care programs.
“The amount of taxpayer dollars flowing through the Medicare and Medicaid programs, along with the complexity of the programs, makes them ripe for abuse. Assisting our clients with the oversight functions for these programs helps to ensure the limited funding available gets used for its’ intended purpose – helping the most vulnerable members of our society.”
— Keith Sorensen
