Orange County Regional Conference
Friday, June 17, 2016
Orange County, CA
Regulatory and Enforcement Update—The Stakes Continue to Intensify
Sara Kay Wheeler, HCCA President, Partner, King & Spalding
- Analyze recent Corporate Integrity Agreement (CIA) trends including:
- Retention of compliance experts;
- Formal risk assessments;
- Enhanced management certifications; and
- Risk-based claims reviews.
- Assess how CIA trends and other compliance developments are shaping government compliance program expectations and provider investigation strategies.
- Analyze significant regulatory issuances, including the issuance of the Medicare Parts A and B overpayment rule and related implementation strategies.
- Explore recent investigative initiatives being pursued by state and federal entities, including the focus on individual accountability, and discuss practical strategies in light of the existing enforcement posture.
Key Stark Law Developments: What Every Compliance Officer Needs to Know
Charles B. Oppenheim, Partner, Hooper, Lundy & Bookman PC
Benjamin Durie, Associate, Hooper, Lundy & Bookman PC
- Provide a brief overview of recent change to the Stark Rule, cases, and recent settlements
- Discuss how these changes will affect professional services arrangements with physicians
- Review compliance challenges and how organizations are addressing these changes
Medicare Part C&D Compliance: What you need to know if you are a First Tier, Downstream or Related Entity (FDR)
Christopher H. Finch, MHA, RN, CHC, Vice President, Chief Compliance and Audit Officer, MemorialCare Health System
Margaret Ngo-Lee, MBA, CHC, Director, Network Management Administration – Compliance, SCAN Health Plan
- This session will discuss the increasing oversight requirements for providers related to the Medicare Part C&D programs
- The relationship between the Health Plans (Sponsors) and First Tier (Providers) entities to help explain and clarify the requirements
- Focus areas will be; annual general compliance and fraud, waste and abuse training, OIG LEIE exclusion screening requirements, policies and procedures, and the attestation process
Effective Strategies for Managing Business Associate Relationships
M. Leeann Habte, Senior Counsel, Foley & Lardner LLP
Shirley Komoto, CHC, Director, Moss Adams LLP
- Review decision framework for identifying business associates.
- Discuss operational issues in managing business associate agreements.
- Highlight key areas and techniques for auditing and monitoring business associates.
Clinical Documentation Improvement (CDI) Programs: What Role Should Compliance Play?
Sharon Hartzel, Director, The Claro Group LLC
Paul Belton, Director of Compliance, Sharp HealthCare
- Understand the basic components and benefits of an effective CDI program
- Discuss Compliance Department roles and responsibilities with CDI
- Highlight how auditing and monitoring the CDI program can help promote compliance and reduce risk
- Recognize opportunities for Compliance and CDI teams to work together