Michelle D. Rigby, CFE, CHC is a Senior Consultant at BluePeak Advisors (BPA). Michelle has 20 years of health care compliance experience at both the health plan and PBM level to include Medicare, Medicaid and Commercial products. She possesses extensive knowledge in the areas of insurance investigations, government audits, Pharmacy Benefit Manager (PBM) services, Medicare A, B, C and D, Medicaid and Commercial Health Plans. The focus of her position is to assist clients with their needs in compliance, audits and FWA as well as interpretation and adherence to governmental regulations.
She has been involved in Medicare Part D since its inception in 2006, helping to launch a plan comprised of seven Blue Cross Plans as well as building the compliance program at a large PBM. Michelle has been the lead auditor on 20 CMS Program audits and completed over 200 CMS audits to date. Her collaboration with operational leads for quality improvement initiatives led to numerous successful audits. Michelle developed a successful, proactive CMS Mock Audit program, to jointly assist the Plan and PBM in being fully prepared and to foster teamwork and collaboration. She has recently completed her certification in MTM to further support audits. Her experience in building FWA programs at the Plan and PBM level has been instrumental to clients looking to add or grow this functionality within their program.
Recently, Michelle managed the Internal & External Audit and corporate Fraud Waste and Abuse programs while helping with Medicare Compliance support for numerous large clients. Michelle is a Certified Fraud Examiner and Certified in Health Compliance and has spoken extensively on FWA and Compliance topics throughout the United States.