Kathleen Duffett, RN, JD, Attorney at Law
Professional History
Kathleen began her health care career as a Registered Nurse, working primarily in the adult critical care areas of two major academic medical centers. After graduating from law school, she litigated medical malpractice and insurance defense matters for Heidell, Pittoni, Murphy & Bach, a well-regarded New York City law firm. Thereafter, she joined the New York State Nurses Association (NYSNA), where she represented unionized RNs in the metro NY area in labor relations and other employment matters.
Subsequent to her NYSNA employment, Kathleen joined Montefiore Medical Center as a Risk Manager. At Montefiore, she provided advice on routine and emergent medicolegal issues to all levels of staff.
Kathleen next joined KPMG as a senior health care consultant, where she focused on fraud and abuse issues. Her responsibilities included developing corporate compliance programs for health care organizations.
Kathleen acquired her managed care expertise while working at the Contract Management Organization, LLC, which is now known as CMO, The Care Management Company. The CMO is a management services organization that contracts with HMOs and IPAs to handle claims processing, credentialing, provider relations, utilization review and other business operations. Initially hired as the Manager of Utilization Review, she quickly went on to become the Director of Corporate Compliance & HIPAA Privacy Officer.
In 2004, Kathleen started her own legal and health care consulting practice. The practice focuses on helping health care organizations and providers understand and meet their regulatory obligations. Her areas of expertise include fraud and abuse, HIPAA, home care operations, hospital operations, managed care and risk management.
Teaching Experience
From 2000 – 2006, Kathleen was a lecturer at Pace University’s Lienhard School of Nursing Legal Nurse Consultant Certification Program. She created the health care regulation module, which provided a comprehensive overview of federal and state laws and regulations governing health care in both the public and private sectors. She has also been an instructor for Mercy College’s Legal Nurse Consultant Program.
Writing Experience
Kathleen has authored several articles on regulatory compliance issues. Here is a sampling of her articles.
- Show Me the Money! Provider Protections Under the NYS Managed Care Reform Act of 2009
(reprinted with permission from Managing Health Today, March 2010, Volume 14, Issue 4,
published by the Hudson Valley Chapter of the Healthcare Financial Management Association)
- News from the Managed Care Battlefield: Out-of-Network Denials and
the New York State External Appeal Law (reprinted with permission
from Health Law Journal, Winter 2009, Vol. 14, No. 1, published by the
New York State Bar Association, One Elk Street, Albany, New York 12207,
(1-800-582-2452), http://www.nysba.org)
- Hitting the Ground Running- What Every New (or Wannabe) Compliance
Professional Needs to Know, Health Care Compliance Association Compliance
Today, Volume 8, Number 11, November 2006 (This article, published
in Compliance Today, appears here with permission from the Health Care
Compliance Association. Call 888/580-8373 with reprint requests.)
- The HIPAA Privacy Rule, Nursing Spectrum, Volume 18A, Number 20, September 25, 2006
- Emergency Care Is a Patient’s Right – Insured or Not, Nursing Spectrum, Volume 17, Number 22, October 24, 2005 (Continuing Education Module – on line version updated July 2007)
- Wouldn’t It Be Nice – Utilization Review Determinations,
External Appeals and the Benefits of Being a Provider Covered by the
New York State Access to End of Life Care Law (reprinted with permission
from Health Law Journal, Winter 2005, Vol. 10, No. 1, published by the
New York State Bar Association, One Elk Street, Albany, New York 12207,
(1-800-582-2452), http://www.nysba.org)
- An Ounce of Prevention: Enhancing the Confidentiality of IPA Quality
Improvement Records (reprinted with permission from Health Law Journal,
Spring 2004, Vol. 9, No. 2, published by the New York State Bar Association,
One Elk Street, Albany, New York 12207, (1-800-582-2452), http://www.nysba.org)
Speaking Experience
Kathleen enjoys speaking to health care professionals about legal and regulatory matters. She welcomes invitations to speak to health care professionals about regulatory compliance issues within her areas of practice. Please contact her if you are looking for a speaker for a program or event.
Here is a partial list of Kathleen’s presentations:
- Confidentiality in the 21st Century, Advanceweb.com National Virtual Job Fair, January 17, 2012
- Desperate Times, Desperate Measures – Legislation That Impacts on Case Managers, Case Management Society of America, New York City Chapter, Annual Meeting, October 2006
- Managed Care in New York State: Current Issues and Future Trends, New York State Bar Association, September 2006 (Co-chair of program and panel moderator for 2005 revisions to NYS Department of Health managed care organization regulations)
- Medical Necessity Denials and Provider Appeal Rights in NYS: A Primer,
Greater New York Hospital Association, March 2005 - Medical Necessity Denials and Provider Appeal Rights in NYS: Where We’ve Been and Where We’re Going, Hudson Valley HFMA Managed Care Forum, October 2004
- HIPAA Privacy Standards: An Overview of the December 2000 Final Rule and the March 2002 Proposed Modifications, New York Association for Ambulatory Care, April 2002
Professional Memberships
Kathleen is a member of the following professional associations:
- American Health Lawyers Association, Payors, Plans and Managed Care Practice Group
- New York State Bar Association, Health Law Section
- Committee on Hospitals and Health Systems
- Committee on Managed Care, Insurance and Consumer/Patient Rights
- Committee on Payment and Reimbursement
- Special Committee on E-Health and Information Systems
- Westchester Women’s Bar Association, Elder and Health Law Committee
- Women’s Bar Association of the State of New York
Board Memberships
- Mosholu Montefiore Community Center, January 2009 - 2011
- Women’s Healthcare Network (an affiliate of the American College
of Healthcare Executives), 2005 – 2006
Educational Background
Kathleen is a graduate of the Bronx High School of Science. She graduated magna cum laude from Boston University, where she majored in Nursing and minored in English Literature. She received her law degree from Albany Law School of Union University.