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P6: Managed Care Enforcement and Compliance Kay Mesia, Principal, Two International Rose Dunn, Chief Operating Officer, First Class Solutions, Inc.
  • FDR enforcement in a Medicare Advantage Plan: Compliance process and oversight
  • RADV expectations of Medicare Advantage for claims data accuracy
  • Deficiency remediation
General Compliance
  • 12:15 PM - 01:30 PM
    Lunch (On Your Own)
  • 01:30 PM - 03:00 PM
    Breakout Sessions
    P7: Negotiating False Claims Act Settlements and Mediation Jack Wenik, Partner, Epstein Becker & Green PC Janice Symchych, Mediator and Arbitrator, JAMS Sean O'Connell, Counsel, Hunton Andrews Kurth LLP Laura Laemmle-Weidenfeld, Partner, Jones Day
    • Latest developments in False Claims Act settlements, including new DOJ policies and the effect of Universal Health Services v. United States ex rel. Escobar
    • Negotiating False Claims Act settlements including corporate and individual settlements
    • Drafting False Claims Act settlement agreements from the defense and government perspectives
    General Compliance
    P8: Handling a Criminal Healthcare Fraud Case Richard Westling, Member, Epstein Becker & Green, P.C. Ralph Caccia, Partner, Wiley Rein LLP Amy Markopoulos, Counsel to the Chief, Healthcare Fraud Unit, U.S. DOJ
    • The role of data in criminal cases
    • Emerging criminal enforcement trends
    • Responding to criminal investigations and prosecutions
    General Compliance
    P9: Enforcement and Compliance for General Counsel and Compliance Officers John Kelly, Member, Bass, Berry & Sims PLC Lisa Adkins, SVP/Chief Compliance and Privacy Officer, University of Maryland Medical System Shannon Sumner, Principal/Chief Compliance Officer, PYA
    • Enforcement agencies, government regulators, and whistleblowers remain focused on pursing health care fraud and abuse matters placing compliance programs and legal counsel as the first lines of defense
    • With so much at risk, our panelists will provide guidance and advice about what is keeping them up at night from the different perspectives of in-house counsel, compliance officer, and outside counsel
    • The panelists will provide advice on best practices to minimize the identified risks and enhance both legal and compliance functions
    General Compliance
  • 01:30 PM - 04:45 PM
    Pre Conference PM
  • 03:00 PM - 03:15 PM
    Networking Break Coffee & Hot Tea available
  • 03:15 PM - 04:45 PM
    Breakout Sessions
    P10: Cyber Security and Health Care Privacy Roy Wyman, Attorney, Nelson Mullins Broad and Cassel David Kessler, Public Sector Product Compliance Counsel, Verizon Marti Arvin, Executive Advisor, CynergisTek, Inc. Joseph Dickinson, Partner, Smith Anderson Blount Dorsett Mitchell & Jernigan, LLP
    • Assessing current cyber security and privacy legal landscape and enforcement actions
    • erging technologies: Cyber security and privacy risks for healthcare-related entities
    • Addressing risks from supply chain and third-party vendors to help reduce enforcement risks
    General Compliance
    P11: Federal Administrative Sanctions: Exclusions, Civil Money Penalties, and Case Update Kristin Carter, Sharehloder, Baker, Donelson, Bearman, Caldwell & Berkowitz, PC Michael Torrisi, Senior Counsel, Office of Counsel to the Insepctor General, U.S. D
    • Overview of HHS-OIG and CMS administrative enforcement tools and sanctions, including civil monetary penalties, exclusions, revocations, and suspensions
    • Trends, priorities, and updates in HHS-OIG enforcement and CMS program integrity actions
    • A review of recent federal administrative healthcare enforcement actions
    General Compliance
    P12: Compliance, Repayment and Self-Disclosure Brian Bewley, Partner - Life Sciences and Healthcare, Goodwin Procter LLP Heather Bokor, Chief Compliance Ofcr, Univ of Florida Health System Nicole Caucci, Deputy Branch Chief, OIG HHS David Fuchs, Senior Counsel, Office of Counsel to the IG, U.S. Department of Health and Human Services
    • Discuss applicable rules and provider obligations to return a known overpayment
    • Discuss best practices in identifying, quantifying, and remedying an overpayment
    • Discuss options and considerations for remedying an overpayment for simple repayments and voluntary disclosures
    General Compliance
  • 04:45 PM - 06:15 PM
    Welcome Reception Join us for a networking reception with our Exhibitors. Light appetizers and beverages will be served.
  • Monday, November 4

    • 07:00 AM - 08:00 AM
      Continental Breakfast
    • 08:00 AM - 08:15 AM
      Opening Remarks Monday
    • 08:15 AM - 09:30 AM
      General Session: Government 1: Enforcement Panel Kirk Ogrosky, Partner, Arnold & Porter Alec Alexander, Deputy Administrator, CMS, Director, Center for Program Integrity, CMS David Tanay, Division Chief, Health Care Fraud Division, Michigan Department of Attorney General Gustav Eyler, Director, Consumer Protection Branch, U.S. Department of Justice Andy Mao, Acting Director, Civil Fraud Section, US Department of Justice Gregory Demske, Chief Counsel to the Inspector General, HHS-OIG Allan Medina, Chief of the Department of Justice, Health Care Fraud Unit, Criminal Division, U.S. Department of Justice
      • Discussion of DOJ Criminal and Civil Enforcement Priorities
      • Discussion of OIG and CMS Enforcement Initiatives
      • Discussion of Medicaid Fraud Enforcement Priorities
    • 09:30 AM - 10:00 AM
      Networking Break Coffee & Hot Tea available
    • 10:00 AM - 11:00 AM
      Breakout Sessions
      101: Collateral Consequences to Audits and Adverse Enrollment Actions Richard Burris, Shareholder, Polsinelli PC Andrew Wachler, Partner, Wachler & Associates, P.C.
      • Discussion of interplay between provider enrollment, claims audits, and False Claims Act liability in today's Medicare landscape
      • Description of interplay between claim audits, such as Target Probe and Educate and UPIC, and adverse enrollment actions
      • Navigating key risk areas that all revoked or terminated Medicare providers need to be aware of, along with practical tips and proactive compliance measures to avoid common pitfalls, including self-audits under the 60-Day Rule
      General Compliance
      102: What Makes a Compliance Program "Effective"?" Thomas Beimers, Partner, Hogan Lovells Heather Bokor, Chief Compliance Ofcr, Univ of Florida Health System Felicia Heimer, Senior Counsel, Office of Counsel To the Inspector General, U. S.
      • Discuss new and historical published guidance on compliance programs, measuring effectiveness, and program evaluation
      • Discuss benchmarking and the use of industry enforcement activity and Corporate Integrity Agreement requirements in your program
      • Discuss tips for achieving effectiveness in your organization and the view from multiple vantage points
      General Compliance
      103: Due Diligence and Compliance Edgar Bueno, Partner, Morris Manning & Martin LLP Lindsey Lonergan, Deputy General Counsel, Navicent Health
      • Learn what is or is not a red flag
      • How to access Information while the government investigates or when a case is under seal
      • Setting expectations as the deal moves forward and how to have productive conversations with the other side
      General Compliance
    • 11:00 AM - 11:15 AM
      Networking Break Coffee & Hot Tea available
    • 11:15 AM - 12:15 PM
      Breakout Sessions
      201: Nurse Practitioners and Physician Assistants: Emerging Compliance Issues for Hospitals Carolyn Buppert, Attorney, Law Office of Carolyn Buppert Elizabeth Skinner, Regional Corp Responsibility Officer, AdventHealth
      • Compliance professionals must understand billing requirements when the rendering clinician is a nurse practitioner or physician assistant and when clinical work is shared with physicians
      • Hospitals should not allow their employed nurse practitioners and physician assistants to be utilized by self-employed physicians. It's a Stark Law problem
      • New state and CDC guidelines on prescribing opioids have opened up a new line of fraud cases involving nurse practitioners and physician assistants. Compliance professionals should have general knowledge of state and national guidelines for prescribing
      General Compliance
      202: Building an Effective Investigative Team Tamra Smith, Compliance/Privacy Manager, Providence St. Joseph Health Mike Sandulak, Director of Investigations, Providence St. Joseph Health Matthew Tormey, Chief Compliance Officer, Ensemble Health Partners
      • Evaluation: Identifying goals, assessing the current program, leveraging internal resources, and defining roles/responsibilities and scope of work. Ensuring investigations are valuable (consistent, high quality), variable (adaptable), and visible.
      • Investigation program elements: Building the team (identifying the right investigators and partners, and developing the right knowledge and skills), assembling the critical tools for your investigation's program, and developing metrics to monitor progress
      • Communicating for success and sustainability: Delivering well-written and complete reports, demonstrating an effective investigations process to reporters and stakeholders, and obtaining buy-in from senior leaders, stakeholders, and your team
      General Compliance
      203: Privacy Breach Response Blaine Kerr, Chief Privacy Officer, Jackson Health System Greg Kerr, Chief Privacy Officer, Ensemble Health Partners