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Handouts

January 27–30, 2019 | Lake Buena Vista, FL

Overall Evaluation | CEU Application | Conference Brochure

P1: Compliance, Privacy, and Security Program Assessment Best Practices

Bret Bissey, Vice President and 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

Presentation 
Evaluation

P2: Lessons Learned on the Frontlines of Network Compliance Enforcement

Deborah Schreiber, Network Compliance Officer, UnitedHealthcare
Niki Jo Kurtis, Medicare 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 to pharmacy networks

Presentation 
Evaluation

P3: 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 and 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

Presentation 
Evaluation

P4: 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

Presentation 
Evaluation

P5: Building an SIU That’s Nimble, Effective, and Audit Ready!

Marita Janiga, Executive Director of National Compliance, Ethics & Integrity Office - Investigations, Kaiser Permanente
Tamara Neiman, Director - National Special Investigations Unit, Kaiser Permanente
Mark Horowitz, Senior Manager - Enterprise Regional Compliance: Care Delivery & Pharmacy, Kaiser Permanente

  • 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

Presentation 
Evaluation

P6: Build a Managed Care Compliance Audit and Remediation Plan

Nicole Huff, Chief Compliance & Privacy Officer, St. Luke’s University Health Network
Deborah Johnson, Senior Director - Compliance and Internal Audit, Peach State 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

Presentation 
Evaluation

P7: I Can Hear You — But Am I Listening?

Jennifer Del Villar, Director of Medicare Compliance, Cambia Health Solutions, Inc
Gail M. 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

Presentation 
Evaluation

P8: Let’s Talk Shop: Changes in MA and Part D Compliance Requirements for 2019

Kate McDonald, Partner, McDermott Will & Emery
Annie Hsu Shieh, Senior Compliance Counsel, Central Health Plan of California
John Tanner, VP - Compliance, Medicare Compliance Officer, Molina Healthcare

  • 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

Presentation 
Evaluation

 

SESSION

SPEAKER

GENERAL SESSION: Combating Fraud, Waste, and Abuse in Managed Care

  • Current trends, vulnerabilities, and developments
  • Update on recent FCA cases
  • Update on recent and planned OIG Audits and Evaluations

Presentation (2 slides/page)

Evaluation

Megan Tinker, Senior Advisor for Legal Affairs, U.S. Department of Health and Human Services, Office of Counsel to the Inspector General

101: Managed Care Expansion in Medicaid and Medicare: Benefits, Challenges, and Compliance

  • 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

Presentation (2 slides/page)

Evaluation

Denise Leard, Attorney, Brown & Fortunato, PC

Pam Felkins Colbert, Attorney, Brown & Fortunato, PC

Angela Brice-Smith, Regional Administrator for Atlanta & Dallas Regional Offices, Deputy Consortium Administrator, CMS

102: Detecting and Preventing Fraud, Waste, and Abuse

  • 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

Presentation (2 slides/page)

Handout

Evaluation

Christina Matsiga, Director of Compliance, HSC Health Care System

103: Not for the Faint of Heart: Preparing CMS Tracer Case Summaries

  • 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

Presentation (2 slides/page)

Handout 1
Handout 2

Evaluation

Anne Crawford, Senior Vice President - Compliance Solutions, ATTAC Consulting Group LLC

Thomas Wilson, Vice President and Compliance Officer, Health Team Advantage

Mary Ann McLean, Vice President of Compliance, Baylor Scott & White Health Plan

201: How Adequate Is Your Provider Network? Applying and Measuring Managed Care Provider Network Compliance Against the New 2018 Requirements

  • 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

Presentation (2 slides/page)

Evaluation

Jennifer Tryder, Program Director, Integrity Management Services, Inc

Michael Walsh, Senior Auditor, Integrity Management Services, Inc

Kimberly Hornik, Vice President of Compliance and Administration, Integrity Management Services, Inc

 


202: Crisis Management for Really Busy People: Learn How to Implement an Efficient and Effective Crisis Management Program in Six Easy Steps

  • 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

Presentation (2 slides/page)

Evaluation

Lee Painter, Principal - CyberSecuirty, CliftonLarsonAllen LLP

Ahmed Salim, Regional Director of Compliance, Presence Health

 


203: Hot Topics in Managed Care Compliance

  • 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

Presentation (2 slides/page)

Evaluation

Ann Beimdiek Kinsella, Compliance and Privacy Officer, Medica Health Plans

Sarah J. Lorance, Senior Vice President & Chief Compliance Officer, Anthem, Inc

Ann Greenberg, Medicare Compliance Officer, Presbyterian Health Plan, Presbyterian Insurance Company

 


301: Engaging Members through Advocacy and Outreach: Addressing Social and Clinical Needs to Minimize Health Disparities

  • 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

Presentation (2 slides/page)

Evaluation

Joynicole Martinez, CEO, The Alchemist Agency


302: Risk Adjustment Compliance and Operations: Building Meaningful Communications

  • 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?

Presentation (2 slides/page)

Evaluation

Nicole Martin, Senior Manager - Prospective Risk Adjustment / Physician Education Team / Prospective Field Chart Review Team Strategic Campaign Solutions (SCS), Florida Blue

Dorothy DeAngelis, Senior Managing Director, Ankura Consulting

 


303: Are You Ready for a Department of Labor Audit?

  • 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

Presentation (2 slides/page)

Evaluation

Amy Christen, Member, Dykema

 


401: Managed Models: The Future of FDR Delegation— Service Delivery, Service Responsibility, and Service Ability

  • 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

Presentation (2 slides/page)

Evaluation

Richard Golfin III, Compliance Officer, CenCal Health

 


402: Federally Facilitated Exchange (FFE) Audits: Do You Know the Risk Areas?

  • Understand the FFE audit process and areas of focus
  • Learn about the FFE audit process
  • Identify FFE risk areas and remediation strategies

Presentation (2 slides/page)

Evaluation

Steve Bunde, Vice President of Integrity & Compliance and Internal Audit, HealthPartners

Dawn Guzik Stocker, Program Manager - Health Care Reform Compliance, Geisinger Health Plan

 


403: A Phish Tale: Lessons Learned from a Successful Phishing Attack in a Managed Care Organization

  • A Medicare Advantage Plan’s incident-response approach to a phishing attack that resulted in a HIPAA breach of over 500 individuals; lessons learned during and after the investigation
  • The obligations and complexities of the overall investigation; reporting to other entities such as the media, OCR, and CMS; 
    the facets of an OCR breach investigation
  • Creative and effective post-breach training and communication strategies used by the plan, designed to reduce the likelihood of future breaches

Presentation (2 slides/page)

Evaluation

Jessica Vander Zanden, Vice President of Administrative Services, Network Health

Angela Keenan, Director, Privacy & Compliance, Network Health

 


GENERAL SESSION: CMS Compliance and Enforcement Update

Presentation (2 slides/page)

Evaluation

Kimberly Brandt, Principal Deputy Administrator for Operations, CMS

SESSION

SPEAKER

GENERAL SESSION: CMS Audit and Enforcement Update

  • Changes to the audit process and proposed data collection requests
  • Changes to the Civil Money Penalty methodology

Presentation (2 slides/page)

Evaluation

John A. Scott, Acting Director, Medicare Parts C & D Oversight & Enforcement Group, Centers for Medicare & Medicaid Services


GENERAL SESSION: The Parity Challenge: Compliance with a Complex Law

  • A family story about the impacts of mental health
  • Mental Health Parity and its impact on health plans  
  • Parity risk areas and how to focus your compliance  resources

Presentation (2 slides/page)

Evaluation

Tim Clement, State Government Affairs - Northeast, American Psychiatric Association


501: Regulators Mount Up: How an Insurance Department Ensures Compliance with Managed Care Plans

  • What a Network Adequacy review for a Managed Care Plan entails
  • DOs and DON’Ts and PROs and CONs when submitting a Network Adequacy plan for review
  • Managed Care Compliance from the perspective of a State agency regulator

Presentation (2 slides/page)

Evaluation

Rachel Chandler, Senior Attorney, Life and Health Actuarial Division, Mississippi Insurance Department

 


502: The WHO, WHY, and HOW of Delegation Oversight

  • WHO qualifies as an FDR and how to tell
  • WHY perform oversight; rules and regulations
  • HOW to do it; steps and best practices

Presentation (2 slides/page)

Evaluation

Christian Puff, Attorney, Hall Render Killian Heath & Lyman, PC

Hayley Ellington-Buckles, Chief Compliance Officer, Versant Health


503: Stress is Stressful

  • Recognize and acknowledge that working in Compliance is incredibly challenging
  • Key strategies to identify and interpret work-tasks, the work environment, and the impact on self
  • Revitalize your compliance “mission” to strengthen your health plan’s compliance program

Presentation (2 slides/page)

Evaluation

Cathy Bodnar, Chief Compliance and Privacy Officer, Cook County Health and Hospital System

Lauren Tockey, Admissions Counselor, Gateway Foundation Alcohol & Drug Treatment Centers


601: Medicare Advantage Risk Adjustment Compliance DOs and DON’Ts: How to Effectively Deploy Limited Resources on Emerging Risk Areas

  • The current regulatory and enforcement landscape related to Medicare Risk Adjustment, including government areas of focus such as: retrospective chart review and targeted interventions/in-home assessments
  • Effective and appropriate measures to ensure the integrity of risk adjustment data being provided to CMS, including applicable auditing and monitoring best practices
  • Methods for conducting thoughtful and effective internal investigations protected by attorney-client privilege

Presentation (2 slides/page)

Evaluation

Jason Christ, Member, Epstein Becker & Green, PC

Teresa Mason, Associate, Epstein Becker & Green, PC

Julie Nielsen, Managing Director, Berkley Research Group, LLC


602: Don’t Freak Out! You Can Survive Multiple CMS Audits at the Same Time— Here’s How

  • Payers can gain value from being better prepared and more productive, and can uncover greater operational insights when multiple audits occur at the same time
  • Payers can lower their risks by understanding how the same set(s) of data may impact multiple audits; scenario planning these impacts is a valuable activity
  • Payers can improve their performance by understanding how overlapping audits impact one another under the Medicare program

Presentation (2 slides/page)

Evaluation

Ryan Hayden, Partner, PricewaterhouseCoopers

Rohit Gupta, Director, PricewaterhouseCoopers

Rezarta Molla, Vice President of Corporate Compliance, Harvard Pilgrim Health Care

 


603: Are You Just Checking the Box or Creating Effective Compliance Training?

  • CMS’s expectations of effective training
  • Components of effective training
  • Catalysts for caring about training

Presentation (2 slides/page)

Evaluation

S. Leah Yoder, Senior Advisor, UL PURE Learning

Shelley Segal, Principal and Co-Founder, Medicare Compliance Solutions

 


701: The State of Play for Mental Health Parity

  • Discerning the state of Mental Health Parity and Addiction Equity Act enforcement under the Trump Administration and avoiding traps for the unwary
  • The 21st Century Cures Act of 2016 called for stepped up enforcement and additional guidance; taking stock of what has been done to date, what’s missing, and what might be to come in terms of both state and federal responses
  • The intersections between mental health parity law and other coverage mandates and federal nondiscrimination rules

Presentation 1 (2 slides/page)
Presentation 2 (2 slides/page)

Evaluation

Tricia Beckmann, Director, Faegre Baker Daniels Consulting

Amy Finley, Senior Counsel, Highmark, Inc

 


702: How to Prepare for 2019 CMS Rule Change to Marketing Materials: ANOCs, EOCs, Summary of Benefits — Issues, Impact, Disclosures, and Audits

  • CMS Expectations: Plans must verify that accurate and complete data is represented on materials; identify benefit changes year-to-year; 
    reduce/eliminate erratas
  • Regulatory Changes: Allowing for e-materials means that plans need to be diligent on data presented to members; CMS’s distinguishing between e-communication and e-marketing materials may lead to more focus and scrutiny on these required materials
  • Audits and Best Practices: Audit issues; disclosed issues to CMS tied to CPE audit and pre-audit issue summary; beneficiary impact; tracer sample

Presentation (2 slides/page)

Evaluation

Debbie Mabari, CEO, CODY

Hannah LaMere, Director - Special Projects, CODY

Mike Turrell, CEO, Ultimate Health Plans


703: The Importance of Automating Your Monitoring and Auditing

  • Do you know where your compliance risk is hiding?
  • How do you move your organization to complete risk identification without adding staff?
  • Why is a central compliance management solution critical for managing and mitigating risk?

Presentation 1 (2 slides/page)
Presentation 2 (2 slides/page)

Evaluation

Pamela Cleveland, VP - Compliance Product Strategy, Beacon Healthcare Systems

Megan Grifa, Director, Medicare Compliance, Medical Mutual of Ohio


801: Understanding Recent Legislative Changes to Coordination of Benefits Practices for Medicaid and CHIP Programs

  • An overview of recent and upcoming changes — due to legislative and regulatory activity at the federal and state levels — which will impact coordination of benefits function for Medicaid and CHIP programs and plans
  • Plan requirements, with a focus on operational compliance and impact on stakeholders
  • Targeted for Medicaid and CHIP plans

Presentation (2 slides/page)

Evaluation

Kristen Ballantine, Vice President of State and Federal Government Relations, HMS

Deborah Grier, Vice President COB Product Strategy, HMS

 


802: The Rise of the Virtual Workforce: Compliance Role in Robotic Automation Governance

  • With Operations and IT teams collaborating on an automation strategy, the role of Compliance in governance cannot be ignored
  • Robotic Process Automation is creating a team of virtual workers —  and an additional layer of oversight requirements
  • How Compliance can join Business and IT in development of a proper governance strategy

Presentation (2 slides/page)

Evaluation

Deana Rhoades, Principal - Automation, Health Plan Consulting, NTT DATA

John Wells, Vice President, Aetna Medicare Compliance, Aetna

Sherrie Ryder, Senior Advisor - Compliance & Security, NTT DATA