Carin Mates is a Managing Director in the Health Solutions segment at FTI Consulting and is based in Atlanta. Ms. Mates primarily specializes in the assessment, review and development of effective regulatory and operational compliance policies, processes, procedures and systems across the healthcare ecosystem. Ms. Mates has more than 15 years of healthcare experience spanning the provider, employer and government markets.
During her time at FTI Consulting, Ms. Mates has focused primarily on assisting healthcare clients with matters related to regulatory and operational compliance. She has advised clients on the development and implementation of compliance programs and ways to strengthen compliance program effectiveness within the provider, post-acute and payor space. As part of this work, Ms. Mates has performed compliance reviews and assessments for organizations in both a proactive manner as part of internal or external due diligence as well as in reaction to government investigations or enforcement actions. This work involves reviews of key compliance program documentation, targeted auditing and monitoring activities and stakeholder interviews with both consumers and leaders of compliance programs.
Ms. Mates often conducts compliance review and assessment activities in connection with corporate integrity agreements (“CIA”) as both the Independent Review Organization (“IRO”) and the Board Compliance Expert. Ms. Mates has served as the day-to-day lead for six IRO engagements at FTI Consulting. These engagements have involved claims reviews, medical necessity and appropriateness reviews, internal risk assessment and audit process reviews, and marketing and enrollment process reviews for health systems, skilled nursing facilities, home health agencies, pharmaceutical distributors and Medicare Advantage (“MA”) plan sponsors. In addition, Ms. Mates served as the primary engagement lead as the Board Compliance Expert under the CIA for a major clinical laboratory.
Prior to joining FTI Consulting, Ms. Mates was an Associate at Booz Allen Hamilton and served as a subject matter expert on health insurance marketplaces for the Center for Consumer Information and Insurance Oversight, with an emphasis on consumer and stakeholder engagement and support, eligibility and enrollment and plan management. Ms. Mates led a team responsible for gathering and analyzing enrollment data from State-based Marketplaces (“SBMs”). She was also a Senior Analyst with Mercer Health and Benefits, working with private and public sector entities to strategically plan for and manage their employer-sponsored health plans. Ms. Mates holds a B.A. in Political Science from Duke University.