Sunday, January 27

  • 08:00 AM - 09:30 AM
    P01 - Compliance, Privacy, and Security Program Assessment Best Practices Bret Bissey, Vice President, Chief Compliance Officer, Gateway Health Kelly McLendon, Managing Partner, CompliancePro Solutions - Ideas for conducting a compliance program review to ultimately reduce overall organizational compliance risk
    - How to utilize the elements of the DHHS OIG Model Compliance Program(s) to develop a work plan to perform this assessment
    - The content of - and tips for performing - HIPAA privacy and security assessments in order to impress OCR and facilitate a high level of compliance which ultimately reduces organizational risk
    General Compliance
  • 08:00 AM - 05:30 PM
    Pre Conference Pre Conference
    100
  • 09:45 AM - 11:15 AM
    P02 - Lessons Learned on the Frontlines of Network Compliance Enforcement Deborah Schreiber, Functional Compliance Officer, UnitedHealthcare Niki Jo Kurtis, Pharmacy Compliance Officer, UnitedHealthcare - Regulatory requirements and expectations for provider and pharmacy networks
    - Lessons learned from current regulatory auditing, monitoring, and reporting requirements for provider networks
    - Why regulators consider network directory data accuracy issues to be a potential access issue and an important beneficiary/consumer protection focus area - and how to apply lessons learned topharmacy networks
    General Compliance
  • 12:30 PM - 02:00 PM
    Breakout Sessions
    #P03
    P03 - Viewing Investigations from a Different Angle: Understanding the Varying Perspectives of Counsel, Compliance Officer, and Prosecutor to Improve Your Internal Investigation Process Heather Fields, Shareholder, Chair - Hospital/Health Systems Practice, Reinhart Boerner Van Deuren s.c. Lisa Estrada, Senior Vice President and Chief Compliance Officer, Fresenius Medical Care North America James Sheehan, Chief, Charities Bureau, NY Attorney General
    • Yates/Sessions focus on individual liability in DOJ corporate investigations - how attorney ethical duties, compliance officer ethical guidelines, and Yates cooperation credit requirements impact interviews and investigation process and documentation
    • Different planning approaches of compliance officer, legal counsel, and prosecutor/regulator to compliance reviews, investigations, and reporting - through case studies and interaction
    • Practical strategies to address investigation challenges and optimize your organization’s ability to achieve the best possible outcome in government investigations or litigation
    General Compliance
    #P04
    P04 - Compliance 101 Shawn DeGroot, President, Compliance Vitals Jenny O'Brien, Chief Compliance Officer, UnitedHealthcare
    • Factors to consider when developing and implementing a compliance program -The elements and keys to maintain an effective compliance programn
    • Introduction of tools and techniques
    General Compliance
  • 02:15 PM - 03:45 PM
    Breakout Sessions
    #P05
    P05 - Building an SIU That's Nimble, Effective, and Audit Ready! Marita Janiga, Vice President, Investigations, Kaiser Permanente Tamara Neiman, Director, Nat'l Special Investigations Unit, Kaiser Permanente Mark Horowitz, Pharmacy Audit and Compliance, Kaiser Permamente
    • The key components of building and leading an effective SIU
      • A "best practice" process for responding to CMS memos and issuances
      • The steps to take in preparing for a CMS Compliance Program Effectiveness Audit
    General Compliance
    #P06
    P06 - Build a Managed Care Compliance Audit and Remediation Plan Nicole Huff Deborah Johnson, Vice President, Compliance, IlliniCare Health Plan

    • Best practices on how to review and audit risk adjustments

    • How to correlate compliance risk assessments and ongoing audit work

    • Tracer summaries, including internal controls, remediation activity, documented outcomes, and remediation effectiveness for a compliance scenario
    General Compliance
  • 04:00 PM - 05:30 PM
    Breakout Sessions
    #P07
    P07 - I Can Hear You - But Am I Listening? Jennifer Del Villar, Dir Gov Pgms Compliance, Cambia Health Solutions, Inc. Gail Blacklock, Compliance Officer , Inter Valley Health Plan
    • When our members call, are we fulfilling all their needs? Appeals, determinations, grievances and inquiries
    • CMS call log universes - the who, where, what, why, and how
    • Monitoring and auditing using call logs universes - both the business area and compliance
    General Compliance
    #P08
    P08 - Let’s Talk Shop: Changes in MA and Part D Compliance Requirements for 2019 Kate McDonald, Partner, McDermott Will & Emery John Tanner, VP Compliance, Medicare Compliance Officer, Molina Healthcare, Inc. Annie Shieh, Sr Compliance Counsel, Central Health Plan of California
    • Understand and prepare for CMS’s encounter data monitoring efforts
    • Reconsider your approach to FDR training in light of CMS changes
    • Implement best practices for preclusion list screenings, new MLR reporting requirements, and other compliance-related changes in 2019
    General Compliance

Monday, January 28

  • 09:45 AM - 10:45 AM
    Breakout Sessions
    #101
    101- Managed Care Expansion in Medicaid and Medicare: Benefits, Challenges,and Compliance Denise Leard, Attorney, Brown & Fortunato, P.C. Pam Colbert, Attorney, Brown & Fortunato, P.C. Angela Brice-Smith, Recently retired Regional Administrator for Dallas & Atlanta Regional Offices, CMS
    • Understanding managed care private insurance plans vs. Medicare/Medicaid government plans
    • Challenges and benefits for beneficiaries and providers in managed care plans for Medicare/Medicaid.
    • The culture clashes of government programs and private insurers
    General Compliance
    #102
    102 - Detecting and Preventing Fraud, Waste, and Abuse Christina Matsiga, Product Compliance Manager, Inovalon
    • Review of requirements for providers participating in federal and/or state-funded health care programs to detect and prevent fraud, waste, and abuse.
    • Examples of what constitutes fraud, waste, and abuse; and a look at some case studies
    • Possible strategies to identify - as well as prevent - fraud, waste, and abuse
    General Compliance
    #103
    103 - Not for the Faint of Heart: Preparing CMS Tracer Case Summaries Anne Crawford, Director, ATTAC Consulting Group LLC Thomas Wilson, VP Compliance Officer, Health Team Advantage Mary Ann McLean, Vice President, Compliance, Baylor Scott & White Health
    • Key considerations when developing a tracer case summary, including a model template
    • Successful strategies for engaging business owners in presenting tracers
    • How to incorporate lessons learned from Plans that have been through a CMS CPE Program Audit
    General Compliance
  • 11:00 AM - 12:00 PM
    Breakout Sessions
    #201
    201 - How Adequate Is Your Provider Network? Applying and Measuring Managed Care Provider Network Compliance Against the New 2018 Requirements Jennifer Tryder, Program Director, Integrity Management Services, Inc. Michael Walsh, Senior Auditor, Integrity Management Services, INc. Kimberly Hornik, VP Compliance & Administration, Integrity Management Services, Inc
    • Key transition strategies; moving forward from the 2002 Network Access Rule
    • Understanding CMS protocols, EQR requirements and state exceptions for evaluating Network Adequacy standards -Best practice recommendations for evaluating and following network adequacy requirements under government approved auditing standards
    General Compliance
    #202
    202 - Crisis Management for Really Busy People: Learn How to Implement an Efficient and Effective Crisis Management Program in Six Easy Steps Ahmed Salim, Director of Ethics and Integrity, iRhythym Lee Painter, Principal, CliftonLarsonAllen LLP
    • Putting a crisis management plan in place doesn’t have to be difficult
    • Six straightforward steps to prepare for crisis events
    • Specific implementation and execution recommendations, including how to overcome obstacles and potential risks to success
    General Compliance
    #203
    203 - Panel - Hot Topics in Managed Care Compliance Ann Kinsella, VP Compliance & Privacy, Medica Sarah Lorance, SVP & Chief Compliance Officer, Anthem, Inc. Ann Greenberg, Executive Director, Compliance Officer, Presbyterian Health Plan
    • What’s on the Priority List for Compliance Officers
    • Program Strategies in a Time of Transformation in the Industry
    • Sharing Best Practices and Lessons Learned
    General Compliance
  • 01:15 PM - 02:15 PM
    Breakout Sessions
    #301
    301 - Engaging Members through Advocacy and Outreach: Addressing Social and Clinical Needs to Minimize Health Disparities Joynicole Martinez, CEO, The Alchemist Agency
    • The unique programmatic structure for effective advocacy and outreach to hard-to-reach and hard-to-engage populations
    • Methods to connect members to culturally relevant and socially constructive resources and assist them as they navigate the system
    • Staff and multidisciplinary resources that are the most efficient
    General Compliance
    #302
    302 - Risk Adjustment Compliance and Operations: Building Meaningful Communications Nicole Martin, Sr. Consultant, Medicare Advantage Risk Adjustment, Wellmed Dorothy DeAngelis, Senior Managing Director, Ankura Consulting
    • Bridging the gap between organizational compliance and risk adjustment compliance
    • Understanding and collaborating with risk adjustment operations in your organization; an example using PPO member to PCP attribution
    • Physician risk adjustment education compliance, internal planning vs external sharing, where do we draw the line?
    General Compliance
    #303
    303 - Are You Ready for a Department of Labor Audit? Amy Christen, Member, Dykema
    • Tips for health insurance issuers on how to prepare for a DOL audit of a group health plan -Tips for a health insurance issuer on how to work with the DOL and the group health plan sponsor to ensure the completeness of audit responses
    • Trends in DOL audits, including areas of focus under PPACA; HIPAA privacy issues that arise in the context of DOL audits; a checklist to track responses
    General Compliance
  • 02:30 PM - 03:30 PM
    Breakout Sessions
    #401
    401 - Managed Models: The Future of FDR Delegation - Service Delivery, Service Responsibility, and Service Ability Richard Golfin, Chief Compliance & Privacy Officer, Alameda Alliance for Health
    • Managed care in California, the nation’s largest Medicaid population
    • In California, health plans delegate clinical delivery and clinical services to non-administrative entities
    • Large Medicaid populations require innovative approaches to integrated delivery and population management
    General Compliance
    #402
    402 - Federally Facilitated Exchange (FFE) Audits: Do You Know the Risk Areas? Steve Bunde, VP Integrity & Compliance & Internal Audit, HealthPartners Dawn Stocker, Prog Mgr, Hlth Care Reform Compliance, Geisinger Health Plan
    • Understand the FFE audit process and areas of focus
    • Learn about the FFE audit process
    • Identify FFE risk areas and remediation strategies
    General Compliance
    #403
    403 - A Phish Tale: Lessons Learned from a Successful Phishing Attack in a Managed Care Organization