Agenda

Sunday, January 26

  • -
    Pre Conference Pre Conference
  • 08:00 AM - 09:30 AM
    P01: Ethics and Compliance Work Plan Essentials that Effectively Mitigate Risk Andrea Share, Exec Director, Ethics/Compliance Strategy & Ops, Kaiser Permanente Chanelle Gamble, Compliance Manager, Kaiser Permanente
    • Explain the importance of conducting an ethics and compliance risk assessment and the relevance of risk assessments in an integrated care setting
    • Describe the key components of a risk assessment, how to conduct a risk assessment, and the role of work planning for effective mitigation
    • Introduce a "simple six step" approach to conducting a risk assessment, review a framework for defining risk, and discuss key takeaways for how the connection between risk assessment and work planning delivers business value
  • 09:30 AM - 09:45 AM
    Networking Break Mingle with your peers in the foyer before your next session starts.
  • 09:45 AM - 11:15 AM
    P02: Cyber Threats and Compliance Challenges: How to Manage Technology Risk Jennifer Griveas, Chief Human Resources Officer & General Counsel, Eliza Jennings Senior Care Network Michael Gray, Vice President of IT and Compliance Officer, Eliza Jennings
    • Identify biggest security threats to healthcare organizations
    • Identify the value of integration of knowledgeable IT personnel into high-level operations team as a means to ensure compliance and effective risk mitigation
    • Describe how best to implement technology solutions to enhance efficiency and productivity without sacrificing organizational security
  • 12:30 PM - 02:00 PM
    Breakout Sessions
    #P03
    P03: The A to Zs of FDR, Delegate, and Subcontractor Oversight Steve Bunde, VP Integrity & Compliance & Internal Audit, HealthPartners Laurena Lockner, Sr Mgr Monitoring & Compliance, HealthPartners Rebecca Fuller, Corporate Compliance Officer, PrimeWest Health
    • Prevent: Learn about CMS and state requirements for FDR, delegate, and subcontractor oversight and areas of audit focus
    • Detect: Understand due diligence, contracting, risk assessment, and auditing and monitoring strategies - including key partnerships
    • Correct: Discover what to do when issues are identified and how to incorporate those into the correct CMS Program Audit Universe
    General Compliance
    #P04
    P04: Compliance 2020: Compliance and Business Roles in Today’s Complex Regulatory Environment James Taylor, Manager, PricewaterhouseCoopers Christopher Schroeder, Director, PricewaterhouseCoopers Taline Avakian, Director of Compliance and Medicare Compliance Officer, Harvard Pilgrim Health Care
    • Key developments and trends across the healthcare industry related to the evolving role of compliance and the role of business units
    • How compliance has helped define the role of meeting regulatory requirements
    • An understanding of embedded compliance support and/or performance/program support teams/units, and how risk ownership is driving the role of business units
    General Compliance
  • 02:00 PM - 02:15 PM
    Networking Break Mingle with your peers in the foyer before your next session starts.
  • 02:15 PM - 03:45 PM
    Breakout Sessions
    #P05
    P05: Effectively Managing Internal Investigations and Regulatory Disclosures Anne Crawford, Director, ATTAC Consulting Group LLC Annie Shieh, Sr Compliance Counsel, Central Health Plan of California Lori Benso, Member, Strategic Health Law
    • Methods to determine if communication infrastructure supports prompt identification of potential issues
    • Strategies for initiating timely investigations that determine beneficiary and organizational impacts
    • Common themes and regulatory disclosure approaches when deciding whether self-reporting to regulators is required or advisable
    • Attorney-client privilege and litigation risk-management strategies
    General Compliance
    #P06
    P06: Compliance Goals in Risk Adjustment Coding Dana Brown, President, Reimbursement Management Consultants, Inc. Dott Campo, Manager, Risk Adjustment Division, Reimbursement Mgmt Consultants, Inc. Rebecca Welling, Senior Director- Coding Compliance, Providence Health Plan Rebecca Welling, Senior Director- Coding Compliance, Providence Health Plan
    • Overview of Risk Adjustment reimbursement in the MA and ACA models
    • Review of Risk Adjustment coding, HCC code capture accuracy, review of coding guidelines, rules & regulations
    • In-depth review of most common compliance issues in coding in an RA environment, isolating the issues and giving tools to analyze them and make good compliant decisions
    General Compliance
  • 03:45 PM - 04:00 PM
    Networking Break Mingle with peers and between sessions.
  • 04:00 PM - 05:30 PM
    Breakout Sessions
    #P07
    P07: Special Supplemental Benefits and the FDRs that Provide Them - Unique Monitoring Challenges They Pose Jennifer Del Villar, Dir Gov Pgms Compliance, Cambia Health Solutions, Inc. Gail Blacklock, Compliance Officer , Inter Valley Health Plan
    • Unique monitoring challenges with unique FDRs
    • Monitoring the member match - right member to the right supplemental benefit
    • Tracking & monitoring health outcomes
    General Compliance
    #P08
    P08: Establishing a Best-Practice Approach for Your Compliance, Privacy, and Security Programs Bret Bissey, Vice President, Chief Compliance Officer, Gateway Health Kelly McLendon, Managing Partner, CompliancePro Solutions
    • Learn how to utilize, in detail, the elements of the DHHS OIG Model Compliance Program(s) to develop a best practice for your compliance efforts
    • Learn how to utilize the HIPAA Privacy and Security regulations and conduct a program assessment to create a best practice standard in your organization.
    • Learn how best to formulate security, privacy, and compliance education programs in your organization, including a focus on being compliant at the top of the organization, by utilizing market knowledge to stimulate learning.
    General Compliance

Monday, January 27

  • 09:15 AM - 09:45 AM
    Networking Break Mingle with peers and exhibitors between sessions.
  • 09:45 AM - 10:45 AM
    Breakout Sessions
    #101
    101: The Compliance Officers Guide to a Successful Audit Michelle Rigby, Director, BluePeak Advisors, LLC Wendy Edwards, President & Chief Executive Officer, ATRIO Health Plans, Inc
    • What can you do today to be prepared for an audit tomorrow?
    • What resources does a compliance officer use to help identify gaps and prioritize issues in a lean organization with competing priorities?
    • Consultants, a compliance officer’s best friend to support mitigation efforts, staffing augmentation, audit prep, and audit support
    General Compliance
    #102
    102: Exclusions v. Preclusions - Insights,Analytics, and Monitoring Best Practices after 1 Year of Releases Michael Rosen, Co-Founder, ProviderTrust, Inc Annie Shieh, Sr Compliance Counsel, Central Health Plan of California Liza Filtz-Freimark, Manager, Provider Operations, DentaQuest
    • Trends, analytics, and learnings from the first year of monitoring & implementation
    • Learn the crossover between the CMS Preclusion List and Federal and State Medicaid Exclusion Lists
    • Predictive insights and future considerations for your provider network operations and SIU teams
    General Compliance
    #103
    103: Implementing a GRC Solution to Manage and Enhance Auditing & Monitoring Natalie Ramello, Vice President Chief Institutional Compliance Officer, UT Southwestern Rebecca Blades, Senior Manager, Audit & Monitoring, CommunityCare HMO, Inc.
    • A roadmap for implementing a comprehensive GRC solution within their organization including how to make GRC successful and how to make it CMS compliant
    • Best practices for adoption of a GRC model for auditing and monitoring
    • An understanding of how to tie risks, policies and controls to your auditing and monitoring activities
    General Compliance
  • 10:45 AM - 11:00 AM
    Networking Break Mingle between sessions with exhibitors.
  • 11:00 AM - 12:00 PM
    Breakout Sessions
    #201
    201: Dual Products and MMP: Navigating State and Federal Oversight Deanna Simonds, Compliance Officer, UnitedHealthcare Anjenette Fenske, Compliance Officer, UnitedHealthcare Marla Rothouse, Centers for Medicare & Medicaid Services
    • The Bipartisan Budget Act of 2018 sets forth requirements for increased integration for Dual Special Needs Plans (DSNPs) by 2021. These unprecedented requirements will impact the landscape of duals products.
    • This panel will provide insight on best practice, challenges, and the future state of dual products from both compliance officers from multiple managed care plans.
    • The audience will hear perspectives from several seasoned compliance professionals overseeing different fully integrated dual products.
    General Compliance
    #202
    202: How Bias and Perception Impact Compliance Ahmed Salim, Director of Ethics and Integrity, iRhythym Walter Johnson, Assistant Privacy Officer, Inova Health System
    • Breaking down why people make bad decisions
    • Understanding how risk perception and inherent tendencies negatively impact compliance
    • Utilizing tools to identify bias to increase compliance within your organization
    General Compliance
    #203
    203: Navigating Compliance Challenges for Integrated Payor-Provider Systems Randi Seigel, Partner, Manatt, Phelps & Phillips, LLP Annie Miyazaki, SVP, Chief Compliance & Privacy Officer, Visiting Nurse Service of New York
    • Key regulatory considerations relevant to intercompany arrangements, patient/member consent, and other documentation
    • Tips for balancing plan versus provider regulatory frameworks and referral source/community partner needs
    • Risks and opportunities in data sharing among affiliates under HIPAA and other privacy laws
    General Compliance
  • 01:15 PM - 02:15 PM
    Breakout Sessions
    #301
    301: Evolving Landscapes: False Claims Act and Managed Care Fraud Edward Baker, Counsel, Constantine Cannon LLP Nicholas Paul, Supervising Deputy Attorney General, CA Dept Justice
    • Medicare Advantage plans, Medicaid MCOs, and their partners, are increasingly attractive targets for FCA whistleblower lawsuits
    • The U.S. DOJ and State MFCUs face many challenges, but are gaining traction against managed care fraud, including risk adjustment and network compliance fraud.
    • Having a written compliance plan is not enough. MCOs must develop and implement systems that steer clear of FCA liability.
    General Compliance
    #302
    302: Proactive vs Reactive in Risk Management - "Ring the Bell!" Fredy Rocha, Compliance Officer, Aetna, Inc. Tiffany Lewis, Director, Compliance, IlliniCare Health
    • Identify challenges and explore practical experiences for conducting an effective risk assessment while building a proactive monitoring and auditing plan
    • Identify proactive risk management, which consists of mitigating the risks of threat events before these might possibly occur and negatively impact the organization
    • Identify reactive risk management, which consists of responding to risk events as they occur to mitigate negative impacts to the organization
    General Compliance
    #303
    303: Rx Data Driven Compliance Monitoring: Opioid Prescribing, Dispensing, and Utilization Francis Grabowski, Director, PricewaterhouseCoopers Ben Wright, Director, PricewaterhouseCoopers Sandhi Ton, Manager - Risk Management Analytics, SCAN Health Plan