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P1: Reduce Your ACA 1557 Risks by Understanding How Cultural Sensitivity Can Add Value

  • Learn about the requirements of ACA 1557 and how health plans are complying with the rule
  • Identify the risk areas of ACA 1557 and understand how to triage and respond to ACA 1557 complaints
  • Understand diversity and what it means to be culturally sensitive
  • Graduate from competency to humility

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Eric Christensen, Medicare Compliance Consultant, SelectHealth

Andrea Share, Compliance Director, Kaiser Permanente

P2: Creating an Effective Vendor Management and Oversight Program

  • Basic steps in creating an effective Vendor Management Program — where to begin
  • Implementing an active Vendor Monitoring Program — making it work
  • Best practices — once you have established a program, what’s next?

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Kay Mesia, CEO/Chief Compliance Officer, Two International

Andre Smith, Director of Vendor Compliance Oversight, Blue Cross Blue Shield of Michigan


P3: Communicating Effectively with Your Key Stakeholders

  • Understand who your key stakeholders are and why effective communication is important
  • Identify key measures/metrics to engage your key stakeholders
  • Exchange insights into reporting best practices through an interactive discussion with participants

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

Laurena Lockner, Senior Manager of Monitoring & Compliance, HealthPartners

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

P4: Independent Auditor Validation Survival Guide: How to Prepare For and Manage Your IAV Vendor and Process — Lessons Learned from the Trenches

  • What to expect — changes since requirements have been implemented; what you “control” and don’t; must-dos; timing challenges; what does and doesn’t go into the report
  • Selecting and working with your IAV — how to manage (and tailor) the workplan; what criteria to use; how to determine “fit”; managing discussions with CMS
  • Key lessons learned — monitoring and managing your clean period; preparing the FDR; preparing for case review; addressing exceptions and observations; what could have been done differently

No presentation available

Mitchel Harris, Partner, PricewaterhouseCoopers

David Curé, Chief Audit Executive, WellCare Health Plans

Renee Treberg, Vice President, Government Programs Compliance, Prime Therapeutics

Melissa Koellner, Vice President, Compliance & Risk Management, Healthcare Services, Humana

P5: Risk, Ransomware, and Resilience: The Next Generation of Patient Safety

  • How do I identify key internal and external risks? Once risks are identified, how do I go about prioritizing them? How do I devise action plans to mitigate risks? How do I measure the effectiveness of internal controls?
  • From crippling ransomware attacks to sophisticated social engineering schemes, healthcare has been devastated by wave after wave of criminal activity. The very same issues that make our hospitals, clinics, and networks vulnerable may also be our greatest assets — but only if you know how to respond effectively.
  • Code Blue Clear: How one hospital survived the largest ransomware attack in history

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Reg Harnish, Chief Executive Officer, GreyCastle Security

Sheetal Sood, Senior Executive Corporate Compliance Officer, New York City Health + Hospitals

P6: Finding and Fighting Fraud, Waste, and Abuse within Managed Care Programs: Strategies to Develop an Effective and Robust FWA Program within Your Health Plan while Ensuring Compliance with Federal and State Regulations

  • Compare and contrast different models of special investigations units
  • Discuss methods of proactively identifying FWA while being in compliance with federal and state compliance and reporting requirements
  • Discuss the need for collaboration with internal and external partners

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Ryan Lipinski, Compliance Officer, Cook County Health & Hospitals System, CountyCare

Lynn O’Dea, Director of Government Programs, Health Care Service Corporation

Catie Heindel, Vice President, Strategic Management Services

P7: It’s Risky Business: Medicare Risk Adjustment

  • Brief summary of CMS risk adjustment requirements and government concerns
  • Compliance program considerations, including policies and procedures
  • Internal audit strategies to review risk adjustment processes and risk score reporting

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Lauren Haley, Member, Strategic Health Law

Dorothy DeAngelis, Managing Director, Navigant

P8: MACRA: Not Just for Providers

  • Gain an understanding of MACRA to realign provider reimbursement to reward for value over volume and implications if you’re not a provider
  • Why it is important for compliance officers to understand MACRA
  • The potential compliance considerations and impact, as a result of providers looking to payers and health systems to support and collaborate to achieve MACRA objectives

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Todd Gower, Advisory Senior Manager, Healthcare & Risk, Ernst & Young

Lisa Alfieri, Manager, Risk and Compliance, Ernst and Young



GENERAL SESSION: Ethics and Compliance: Do You Need Both in Order to Operate an Effective Compliance Program? Yes!

  • What does your board of directors need to hear about how you have integrated ethics and compliance into your effective compliance program?
  • Why do ethics and compliance go hand in hand to strengthen your compliance program and fundamentally root employees’ trust in your organization?
  • How will your compliance program benefit from talking about ethics on a regular basis when compliance is also always front and center in your organization?

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Mark Chilson, Executive Vice President and General Counsel, CareSource

Jeffrey McFadden, Partner, Stradley Ronon Stevens & Young, LLP

Courtney Thiele, Instructor, Division of Bioethics, The Ohio State University College of Medicine

101: Mental Health Parity: Managing Compliance Across Commercial, Medicaid, and Duals Products

  • Hear an explanation of — and contrast between — the commercial and Medicaid Mental Health Parity final rules, as well as selected states’ Parity requirements
  • Discover how Parity compliance differs from general program compliance
  • Gain insight into the range of enforcement initiatives by state and federal entities
  • Learn about other key issues, such as: who is responsible for assessing parity, how to address behavioral health carve-outs, correctly identifying and analyzing non-quantitative treatment limits, and steps to ensure ongoing parity compliance

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Helaine Fingold, Senior Counsel, Epstein Becker Green

102: Provider Networks: Renewed Scrutiny on Adequacy and Accurate Directories

  • Where we are today and how we got here
  • Federal and state oversight and enforcement
  • Practical solutions and best practices

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Renee Kimm, Assistant Compliance Counsel, Central Health Plan of California

Ryan Morgan, Attorney, Polsinelli PC

103: Compliance Training: Exploring New Frontiers for Better Learning Transfer

  • Microlearning: What is it and how does it work to improve learning?
  • Practice makes permanent: What type of practice and when?
  • Performance support: How is it different from training?

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S. Leah Yoder, Ed.D., MSN, RN, Senior Advisor, UL

201: “Gimme a C, Gimme an A, Gimme a P… What’s That Spell? CAP!” — Does It Work for You? Effective Strategies for Managing Corrective Action Plan Process After Surviving a CMS Program Audit

  • Learn strategies for drafting a corrective action plan that includes decision-making elements used in the selection of most effective remediation outcome
  • Discuss strategies for securing middle management and vendor involvement in the CAP process
  • Examine how a Plan ensures their CAP is working properly

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Anne Crawford, Director, ATTAC Consulting Group LLC

Clifton Schmidt, Medicare Compliance Officer, SelectHealth


202: How to Effectively Work with Your PBM During a CMS Audit

  • Understand the unique Covered Entity — PBM compliance challenges
  • Learn strategies that you and your PBM can employ to make a CMS audit less cumbersome
  • Hear about the latest major Federal/State compliance changes that you and your PBM need to be aware of

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Robert Thieling, Vice President of Internal Audit, MedImpact Healthcare


203: Culture of Compliance: Why is Transparency the Best Medicine for Your Compliance Program?

  • How do you modify business behavior when you don’t have direct authority?
  • What honest and frank reporting has the most impact on senior leadership?
  • What does my board expect from compliance transparency?

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Maria Phelps, Manager, Enterprise Risk, CareSource

Margaux Frazee, Director of Corporate Compliance, CareSource


301: Applying New Department of Justice Compliance Standards to the Managed Care Context

  • In February 2017, the Department of Justice’s Fraud Section issued guidance regarding its evaluation of corporate compliance programs; the DOJ approach could become the new industry standard.
  • It is important for organizations operating in the managed care space to know how to adapt these new principles to their existing and future compliance programs.
  • In addition to Mr. Caccia, the panel will include a Government attorney and an in-house attorney to provide diverse perspectives on DOJ’s new corporate compliance standards.

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Ralph Caccia, Partner, Wiley Rein LLP

Randolph S. Sergent, Vice President & Deputy General Counsel, CareFirst, Inc.

302: “Hear Ye! Hear Ye! Here Come the Regulators — Managed Care Organizations Getting Audit Ready!”

  • Become familiar with value-add advantages and associated processes necessary to create an auditing and monitoring program with limited resources
  • Discuss lessons learned on “how to” provide value to vendors and subcontractors in a complex managed care environment
  • Become familiar with best practices on how to develop control measures to manage, audit, monitor, and report risk related to outcomes

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Deborah Johnson, Senior Director of Compliance and Internal Audit, Peach State Health Plan

Nicole Huff, Chief Compliance & Privacy Officer, St. Luke’s University Health Network


303: MRA Compliance: Navigating a Sea of Change

  • Review a strategic framework for developing a Medicare Risk Adjustment compliance program
  • Discuss analytical techniques and tools for identifying areas of risk originating from provider and vendor diagnosis code submissions
  • Highlight methods for conducting internal investigations relating to Medicare Risk Adjustment issues

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Aaron Vandervelde, Managing Director, Berkeley Research Group

Stephen Sullivan, Partner, O’Melveny & Myers


401: Top Proven Tips for Communicating with CMS to Improve Your Day-to-Day

  • Your relationship with CMS can significantly improve (or hurt!) the day-to-day environment your plan operates within.
  • Hear real-world tips and examples that health plans have implemented to improve their relationship with CMS operational teams and auditors to minimize the plan’s uncertainty and risk, and to improve their operations.
  • Learn how plans have built relationships that have helped during CMS program audits and subsequent independent validation audits and how relationships have helped navigate the fine line of how and when to self-disclose issues or potential non-compliance.

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Derek Frye, Audit & Technology Leader, Burchfield Group

Wendy Richey, Chief Compliance Officer, Clover Health


402: Role of Ethical Leadership

  • What is ethics and what makes it difficult within organizations to define and drive?
  • As a leader, how can you ensure that your team is not only making decisions based on compliance, but also with ethics in mind?
  • Are ethical decisions the same as compliant decisions?

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Timshel Tarbet, Director, Ethics & Integrated Strategy Management, Cambia Health Solutions

Jory Chase, Ethics Consultant, Cambia Health Solutions


403: Beyond the BAA: Don’t Forget About the White Elephant in the Room — Understand the Compliance Requirements of a Data Use Agreement

  • What a DUA is and where they are commonly used
  • Impact of violating provisions within the DUA
  • Establishing controls to minimize risk to your organization

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Aaron Lund, Director of Compliance and Privacy Officer, Northwell Health


GENERAL SESSION: Health Policy Update from Washington

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Jonathan Morse, Deputy Director for the Center for Program Integrity, Centers for Medicare & Medicaid Services



GENERAL SESSION: Insights from CMS on Program Audits and Oversight

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Vikki Ahern, Medicare Parts C and D Oversight and Enforcement Group, Centers for Medicare & Medicaid Services


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

501: Compliance Audit Transformation (from a Sponsor’s Perspective)

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Vikki Ahern, Medicare Parts C and D Oversight and Enforcement Group, Centers for Medicare & Medicaid Services

Peggy Fry, Director of Regulatory Compliance, Medicare Compliance Officer, BlueCross BlueShield of Tennessee

Milagros Yzquierdo, Chief Compliance Officer, Healthsun Health Plans

Kate Mihalevich, Vice President and Chief Compliance Officer, Express Scripts, Inc


502: Effective Compliance Oversight: The Role of Compliance vs. The Role of Operations

  • How health plans clearly define compliance accountability
  • Roadblocks that prevent effective execution of compliance oversight between compliance and health plan operations
  • What successful health plans do to avoid and address those roadblocks

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Richard Merino, Managing Director, PricewaterhouseCoopers

Sarah Lorance, Vice President of Complinace, Medicare, Anthem

503: Credentialing and Oversight of a Non-Clinical Provider: A Non-Emergency Medical Transportation Case Study

  • Everyone in healthcare compliance is extremely familiar with credentialing/re-credentialing and provider oversight; and to the vast majority, that knowledge is understandably focused on clinical providers.
  • But the network also has non-clinical providers and as overall auditing by CMS and state Medicaid plans has increased in volume and expanded in scope, so does the importance of some of these providers.
  • In this presentation you will hear from both the MCO and the Broker to get their unique perspectives as they negotiate and translate a system primarily designed for the clinical environment.

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Mike Sawyer, Director of Corporate Compliance, Veyo Healthcare Logistics

Cheyenne Ross, Vice President of Compliance & Regulatory Affairs, Centene Corp

601: Medicare-Medicaid InteGREATion: Compliance for Dual-Eligible Products

  • Learn about the unique programs that provide coverage for individuals eligible for both Medicare and Medicaid, including Dual Special Needs Plans (DSNP), Fully-Integrated Dual Special Needs Plans (FIDE-SNP), and Medicare-Medicaid Plans (MMP)
  • Focus on some of the unique and complex compliance issues that can come up in products that serve dual-eligible individuals
  • Hear about some of the key considerations for administering a Compliance Program in health plans that administer dual products

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Anjenette Fenske, MMP Compliance Officer, UnitedHealthcare Community & State

Deanna Simonds, Compliance Officer, UnitedHealthcare Community Plan of MA, UnitedHealthcare Community & State

Alison Green, Director, Medicare Compliance, UnitedHealthcare Medicare & Retirement


602: Managing a SIU in a Managed Care World

  • Establishing a SIU department and staffing challenges
  • Managing workloads both reactive and proactive to meet regulatory requirements
  • Coordinating the referral process, coordinating with regulators and law enforcement and reporting

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Christopher Horan, Vice President of Corporate Compliance Investigations, WellCare


603: Healing the Healer: How to Find Happiness in a High-Stress Profession

  • Address the multiple causes of stress within the healthcare and compliance world
  • Understand how to better take care of yourself (mentally, physically, and emotionally) so that you can better care for your patients and employees
  • Learn realistic techniques to combat burnout and stress using helpful tactics such as meditation, journaling, and affirmations

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Saud Juman, President & CEO, PolicyMedical Inc

Shawn DeGroot, President, Compliance Vitals


701: Medicare Advantage and Medicaid Managed Care Compliance from the First Tier or Downstream Entity’s Perspective

  • Analysis of the required flow-down provisions to be included in subcontracts of Medicare Advantage (MA) and Medicaid managed care plans
  • Obligations of MA and Medicaid plans to oversee subcontractor performance and subcontractor strategies for facilitating this oversight efficiently
  • Compliance program expectations for subcontractors, how to determine what is appropriate for a particular type of business, and handling disagreements over interpretation of regulations and sub-regulatory guidance

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Elizabeth Lippincott, Managing Member, Strategic Health Law

Bruce Tavel, Senior Vice President, General Counsel, Chief Compliance Officer, Superior Vision


702: Where the Rubber Hits the Road: Expert Tips and Techniques to Proactively Assess Your Organization’s Compliance with the New Encounter Data Reporting Requirements

  • Specifically and comprehensively defining the term “encounter” within MCO contracts
  • The importance of usable and audited encounter data as an effective means for Program Integrity
  • Best of practice auditing protocols to measure and monitor encounter data transactions

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Jennifer Tryder, Senior Program Manager, Integrity Management Services, Inc.

John Hapchuk, Consultant, Integrity Management Services, Inc.

703: The Art of Accelerating Change

  • Understand the change management process and individual responses to change
  • Describe team development and the importance of structure
  • Demonstrate ways to make meetings fun and engaging with ice breakers to promote productivity

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Vicki Nolen, Director, Project Deployment Office, Methodist Health System

Katie Garms, Manager, The Improvement Academy, Methodist Health System

801: CMS Appeals Timeliness Monitoring: How to Prepare for the New Annual Reviews

  • How can Medicare Advantage plans and their First Tier, Downstream and Related Entities (FDRs) prepare for the new CMS Appeals Timeliness Monitoring?
  • What activities are beneficial in conducting and remediating any known data-to-source mismatches prior to CMS webinars?
  • What leading practices can Medicare Advantage plans put into place to help better analyze data universes for operational compliance performance and CMS Program Audit readiness?

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Richard Merino, Managing Director, PricewaterhouseCoopers

Jeffrey Smagula, Chief Compliance and Ethics Officer, Tufts Health Plan

Chris Schroeder, Compliance Director, Cedars-Sinai


802: Compliance Readiness: Beyond the CMS Compliance Program Effectiveness Audit

  • Operationalizing your risk assessment
  • Developing your team
  • Key relationships and networking

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Ann U. Greenberg, Director of Compliance, Medicare Compliance Officer, Presbyterian Health Plan, Inc.

Keith McRee, Chief Compliance Officer, Geisinger Health

John Wells, Vice President of Medicare Compliance, Chief Medicare Compliance Officer, Aetna