NIURKA ADORNO-DAVIES
Mt Pleasant
Summary
Dynamic attorney with extensive expertise in government healthcare programs, specializing in Medicare, Medicaid, and Marketplace compliance. A strong track record of interpreting and applying intricate regulations to uphold program integrity and provide strategic guidance on public sector contracts is demonstrated. Licensed to practice in Puerto Rico and federal courts, with a Healthcare Compliance Certification (CHC) obtained in 2010. Proficient in navigating complex legal frameworks across state and federal landscapes, ensuring comprehensive compliance and effective risk management.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Associate Vice President, Compliance/ Compliance Officer
Molina Healthcare, Inc.
01.2015 - Current
- Interim Compliance Officer for Kentucky (May 2025 to July 2025)
- Compliance Officer for Puerto Rico and South Carolina (November 2017 to April 2019)
- Compliance Director North Charleston, SC (June 2017 to November 2017) Molina Healthcare of South Carolina, Inc.
- Compliance Director, San Juan, PR (January 2015 to June 2017) Molina Healthcare of Puerto Rico, Inc., San Juan, PR
- Oversees and directs implementation and day to day operations of the Medicaid, Medicare, and Marketplace Compliance Programs, Compliance Plan, Code of Conduct, and Fraud, Waste and Abuse Plan across the business while ensuring compliance with governmental and contractual requirements.
- Developed and implemented policies aligning with organizational goals to ensure compliance with regulatory standards.
- Collaborated with cross-functional teams to drive process improvements and innovation.
- Mentored junior team members, providing guidance on best practices and strategies to overcome challenges while simultaneously strengthening their professional skillsets.
- Assisted in recruiting, hiring and training of team members.
- Reported issues to higher management with great detail.
- Led investigations of compliance violations, documenting findings and recommending solutions.
- Assisted with internal and external audits to confirm compliance with applicable laws and regulations. Represents Molina with regulatory agencies in external audits.
- Monitor overall compliance environment, and work directly with business units to drive/ensure enterprise compliance.
- Provides leadership on training and education of compliance requirements. Provides specialized compliance education and training when necessary.
- Enforces the Compliance Plan, Code of Conduct and Anti-Fraud Plan.
- Prepares written reports to inform the BOD and Compliance Committee no less than quarterly, the status of activities pertaining to overall Health Plan compliance.
- Provides oversight and assist in on-going facilitation and monitoring of the delegation oversight functions and responsibilities.
- Oversees and directs Compliance, Fraud, Waste and Abuse incidents response management process including investigation, mitigation, reporting, remediation, and training.
- Compile and maintain an accurate centralized list of key business compliance risks.
- Perform annual risk assessment.
- Chair the Regulatory Compliance Committee.
- Partner collaboratively with central compliance team to ensure high risk compliance issues are effectively addressed.
- Coordinates development of written policies and procedures regarding compliance with local, state and federal guidelines.
- Support other markets as Interim Compliance Officer.
- Supervised a team of 3-4 employees from 2015 to 2018.
Corporate Compliance Director
First Medical Health Plan, Inc.
01.2011 - 01.2014
- Reports compliance matters directly to the Board of Directors and the President.
- Liaison between CMS, MEDICS, Office of the Commissioner of Insurance, Puerto Rico Health Insurance Administration (ASES), Office of Inspector General (OIG), or any other state or federal government agency.
- Supervises the Compliance Medicare division, Commercial Compliance division, Special Investigations Unit and Privacy Unit to ensure that the goals of the Department are met.
- Develops and contributes to the development of First Medical’s policies and procedures.
- Represented First Medical as a Member of the Association of Insurance Companies of Puerto Rico (ACODESE).
- Consults with the In-House Attorney or External Counsel, as needed, to resolve difficult legal compliance issues.
- Coordinates, conducts and documents pre-delegation audits and make recommendations to senior management regarding continuation of the contracting process.
- Identifies and monitors the identification of potential areas of vulnerability and compliance risk; develops/implements and monitors corrective action plans for resolution of problematic situations and provides general guidance on how to avoid or deal with similar situations in the future.
- Institutes/maintains and oversees an effective compliance communication program for the organization, including promoting (a) use of the Hotline; (b) heightened awareness of Standards of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures.
- Member of the Medicare/OIG Taskforce.
- Conducts and oversee investigations, as appropriate.
- Conducts privacy, fraud, waste and abuse compliance trainings.
- Supervised eight (8) employees.
- Collaborated with cross-functional teams to identify compliance risks and implement effective mitigation strategies.
- Reviewed and revised internal policies to align with changing regulations in healthcare compliance.
- Enhanced corporate compliance by developing and implementing effective policies and procedures.
- Fostered a culture of integrity by leading employee training programs on ethics and compliance topics.
- Promoted transparency within the organization by establishing clear communication channels for reporting suspected violations or seeking clarifications on compliance matters.
- Elevated board awareness on significant compliance matters by presenting insightful reports at regular meetings, enabling informed decision-making processes.
- Provided guidance on regulatory changes impacting organizational operations and compliance frameworks.
- Mentored junior staff on compliance best practices, fostering a culture of accountability and ethical behavior.
- Reduced risk exposure by conducting thorough due diligence on potential business partners and vendors.
Compliance Officer/Staff Attorney
MC-21 Corporation
01.2009 - 01.2011
- Interaction on a daily basis with the General Counsel, the President and the Executive Committee to discuss complex issues as well as regulations that have a direct impact to the corporation.
- Develop and monitor implementation and compliance with program specific related policies and procedures.
- Create and coordinate, or appropriately delegate, educational training programs to ensure that Employees working on a Medicare or other governmental program are knowledgeable of the Compliance Program, the Code of Conduct, and the applicable statutory, regulatory and other requirements.
- Respond to reports of potential instances of fraud, waste or abuse, including the coordination of internal investigations and the development of appropriate corrective or disciplinary actions, if necessary.
- Manage day to day operation of the Compliance Program and assess business risk for non- compliance issues.
- Report, as appropriate and in consultation with the General Counsel, fraud related to the Part D program to the Centers for Medicare and Medicaid Services (“CMS”), its designee and/or law enforcement.
- Review and update MC-21’s Compliance Program at least, annually, and as required by events, such as changing in the law, or discovered flaws in the Program.
- Appointed as the corporation Privacy and Security Officer.
- Provide recommendations to contracts drafting, renewals, negotiations and other legal documents.
- Assist the General Counsel in the management of external counsel and general litigation.
- Maintain and monitor compliance with URAC Standards.
- Actively participates in the Quality Assurance Committee.
Education
Juris Doctorate - Law
Interamerican University of Puerto Rico School of Law
San Juan, PR05-2000
BBA - Business Administration
University of PR, Mayaguez Campus
Mayaguez, PR05-1996
Skills
- Bilingual Communication – Fluent in English and Spanish; adept at navigating multilingual environments and communicating complex concepts clearly
- Legal & Regulatory Research – Strong analytical and legal research capabilities; experienced in interpreting federal and state healthcare regulations
- Technology Proficiency – Skilled in Microsoft Office Suite and QNXT platforms; quick to adapt to new systems and tools
- Independent & Collaborative Work – Equally effective working autonomously or leading within cross-functional teams
- Organizational Excellence – Highly organized with exceptional attention to detail; effective in managing competing priorities and deadlines
- Written & Verbal Communication – Strong drafting, reporting, and presentation skills tailored for legal, compliance, and executive audiences
- Decision-Making Under Pressure – Confident, composed, and solutions-oriented in fast-paced and high-stakes environments
- Strategic Problem Solving – Skilled in identifying issues, analyzing root causes, and implementing practical, compliance-focused solutions
Affiliations
- Puerto Rico Bar Association August 2002 to Present
- Health Care Compliance Association January 2010 to Present
- Committee Member- HCCA San Juan Regional Conference October 2013 to Present
- SCCE/HCCA BOD November 2021 to Present
- SCCE/HCCA BOD Executive Committee- Secretary November 2023 to October 2024
- SCCE/HCCA BOD Executive Committee- Non-Executive Member November 2024 to Present
Certification
Certified in Healthcare Compliance 2010
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
BAR ADMISSIONS
- U.S. Court of Appeals, First Circuit 2002
- Puerto Rico Supreme Court 2002
- Federal Court, District of Puerto Rico 2013
SPEAKER
- 2024 HCCA Compliance Institute, Nashville TN, April 13-17, 2024- Session W12 Navigating the Compliance Landscape: Overcoming Obstacles on the Path to Success
- 2023 HCCA Compliance Institute, Anaheim, CA, April 23-26, 2023- Session P4 Swimming with Sharks: A Compliance Officer’s Guide on Working with Legal Counsel
- Healthcare Enforcement Compliance Conference, Virtual, November 7-9, 2022- Session - Managed Care Enforcement and Compliance
- 2021 HCCA Compliance Institute, Virtual, April 19-22 – Session T3D- Living in Paradise: Thriving and Succeeding in a Remote Work Environment
- 2020 HCCA Compliance Institute, Virtual, March 30 – April 1, 2020 – Session 209- Remotely Speaking: Strategies for Effective Remote Employees and Their Employers
- 38th AHIA Annual Conference, Nashville, TN, September 15-18, 2019- Provider Compliance: It’s not a Mission Impossible
- 2019 HCCA Regional Conference, San Juan, PR, May 16-17, 2019 – Puerto Rico False Claims Act: Perspectives and Implication to your Compliance Program
- 2018 HCCA Regional Conference, San Juan, PR, May 17-18, 2018 – Enforcement and Compliance: Strategies for General Counsel and Compliance Professional Panel
- 2016 HCCA Regional Conference, San Juan, PR, April 28-29, 2016 – Manage Care Compliance Panel & Effective Compliance for Organizations
SEMINARS
- 2025 HCCA Compliance Institute, Las Vegas, NV April 28- May 1, 2025
- 2024 HCCA Compliance Institute, Nashville, TN April 13-17, 2024
- 2023 SCCE Compliance and Ethics Institute, Chicago, IL October 2, 2023
- 2023 HCCA Compliance Institute, Anaheim, CA April 23-26, 2023
- 2023 European Compliance and Ethics Institute, Amsterdam, NL March 20-22, 2023
- FCPA Recent Enforcement Matters December 2, 2022
- 2022 HCCA Compliance Institute, Phoenix, AZ March 28-31, 2022
- The NSA Turns One: Implementation Lessons from 2021 February 7, 2022
- Compliance Culture Case Studies January 10, 2022
- 2021 HCCA Compliance Institute, Virtual April 19-22, 2021
- 2020 HCCA Virtual CI March 30- April 1, 2020
- SCCE/FBI Corporate Compliance Officer Outreach Event July 17-18, 2017
Timeline
Associate Vice President, Compliance/ Compliance Officer
Molina Healthcare, Inc.
01.2015 - Current
Corporate Compliance Director
First Medical Health Plan, Inc.
01.2011 - 01.2014
Compliance Officer/Staff Attorney
MC-21 Corporation
01.2009 - 01.2011
Juris Doctorate - Law
Interamerican University of Puerto Rico School of Law
BBA - Business Administration
University of PR, Mayaguez Campus