Mahveen F. Hussain, M.D.

Assumes responsibility for the medical care for at risk elderly patients enrolled in a PACE program. Supervision of nurse practitioners, including hiring, training, and clinical support. Participation in interdisciplinary team. Developed on-site palliative care program, including palliative care consults, goals of care discussions, and clinical symptom management.

• Perform medical reviews of clinical documentation and provide medical necessity determinations for a national company who contracts with the federal government. Reviews also include fraud, waste, and abuse detection. The position is part of the company's Universal Program Integrity Contract-West (UPIC-W) team, focusing on Medicare and Medicaid Hospice beneficiaries residing in the 13-state CMS UPIC Western Jurisdiction. Current focus of review is Medi-Cal beneficiaries in hospice programs throughout California.

• Overhauled management of physicians , including recruiting, hiring, on-boarding, training, communications, compliance and evaluations. Oversight of approximately 105 physicians in 19 states(Medical Directors and Hospice Physicians)
• Significantly reduced utilization of non-formulary medications by working with pharmacy partners, area leaders, physicians, and nurses
• Successfully responded to Medicare and Medicaid audits (e.g. ZPIC, UPIC, TPE) and claim denials ; response includes, but not limited to, case reviews, written responses, and representation at ALJ hearings
• Launched new Palliative Care initiative in California Assembled policies, procedures, templates, and education for the program and served on the IDT.
• Enhanced training of other clinical disciplines , including nurse practitioners and nurses as well as non-clinical staff, such as sales and marketing
• Collaborated across departments to produce policies, documentation and audit templates, presentations, and videos. Departments include: compliance, education, clinical information systems, and government relations.
• Provided physician leadership on key committees , including the national QAPI committee, ethics committee, physician credentialing committee, and Governing Body.

• Responsible for the overall medical direction of the hospice program
• Provided physician direction and guidance to the Interdisciplinary Team
• Served as a liaison and contact between the hospice program and community physicians
• Assured appropriate evaluation, certification and recertification of terminal prognosis at the time of admission and at the end of each certification period
• Provided direct patient care by performing both medically necessary visits, as well as regulatory visits for hospice services, as well as specialist level care for the palliation of end-of-life symptoms
• Conducted educational seminars and presentations to physicians, nurses and other health care and lay audiences in order to improve quality of patient care and and increase patient access to end-of-life services

• Provided oversight and supervision of approximately 50 physicians in a designated region to ensure the performance of duties consistent with company policies and procedures. Physicians included medical directors and hospice physicians.
• Assisted with recruiting, hiring, mentoring, and education for new and existing company physicians.
• Provided assistance to the regional team to address performance issues involving existing company physicians or concerns with primary providers.
• Served as clinical advisor for the regional clinical services and operations teams, providing guidance on current clinical practices, policies, and procedures, as well as assisting with the evaluation of new clinical programs.
• Served on designated committees, including quality assurance (QAPI) and credentialing committees.
• On QAPI committee, assisted with integrating outcomes data and results into current company practice to improve quality of care.
• Acted as a clinical consultant for the legal team to help evaluate proposed improvement processes toward reduction of both survey exposure and risk for litigation.

• Provided outpatient medical services to San Joaquin County employees at the onsite Employee Health Services clinic. Services included primary care, chronic disease management, and Worker's Compensation.

• Provided primary care, chronic disease management, and acute inpatient care

• Provided primary care, chronic disease management, and urgent care services