Agenda

Sunday, January 31

  • 08:00 AM - 09:30 AM
    P1 Building and Evolving Your Program Integrity Compliance Program Rick Munson, Program Integrity Chief Compliance Officer & VP Investigations, United Healthcare Michael Jurmu, Compliance Auditor, UnitedHealthcare Matthew Berls, Sr. Director of Investigations, UnitedHealthcare
    • Program Framework - Aligning Payment Integrity, SIU, relationships with Government Agencies and Program Integrity Efforts
    • Program Governance - Prevention, Detection and Correction Strategies
    • Program Value Proposition - Innovation and Use of Data
  • 09:30 AM - 10:00 AM
    Networking Break
  • 10:00 AM - 11:30 AM
    P2 Covid-19 and Lessons Learned for Flexible Care Management Approaches (Panel discussion with Humana, WellCare, and HealthFirst; facilitated by PwC) Robert Parker, Manager, PricewaterhouseCoopers Valerie DeBoe Gretchen Wagner, Risk Management Director, Humana
    • A panel discussion on lessons learned from the Coronavirus pandemic and how health plans redeployed staff, adjusted processes, prioritized member outreach, and lessons learned for future emergencies and disruptions.
    • How were plans able to successfully deploy employees, including FDR staff, to provide remote care management services while proactively providing accommodations to high risk members?
    • What processes and organizational responses will your organization retain for future national or local emergencies (e.g., natural disasters)? What areas of improvement have been highlighted throughout this experience?
  • 11:30 AM - 12:45 PM
    Lunch (on your own)
  • 12:45 PM - 02:15 PM
    Breakout Sessions
    #003P
    P3 Building a Cybersecurity Auditing and Monitoring Plan Michael Gray, Eliza Jennings Jennifer Griveas, Chief Human Resources Officer & General Counsel, Eliza Jennings Senior Care Network
    • Upon completion, participants will be able to understand the biggest security threats to health care organizations and highlight most vulnerable systems and populations.
    • Learn to assess compliance risk related to common technologies and equipment, with focus on developing an auditing and monitoring plan for meeting the mandates of the HIPAA Security Rule and other applicable substantive cybersecurity requirements.
    • Speakers will review how to take results of auditing and monitoring activity to build a strong work plan to mitigate risks associated with technology.
    Pre-Conference Basic
    #004P
    P4 How to Build a CPE Tracer: Best Practices to Focus on Prevention, Detection, and Correction Using Misclassified Grievances Michelle Larson, Senior Consultant, Cody Consulting Group Mildred Koranteng, Sr. Director, Compliance and Vendor Oversight, Medica Hannah LaMere, Director, Special Projects, Cody Consulting Group, Inc.
    • Prevention: Apply prevention methods to avoid misclassified grievances, identify training needs, review of regulations, guidance and audit protocols, updating policies and procedures.
    • Detection: Provide suggestions on how to add rigor to compliance staff oversight of call routing and classification of inquiries, grievances, organization determinations, coverage determinations
    • Correction: Learn the critical questions to consider when building Corrective Action Plans. A template will be reviewed.
    Pre-Conference Intermediate
  • 02:15 PM - 02:45 PM
    Networking Break
  • 02:45 PM - 04:15 AM
    P6 Corrective Action Plans & Root Causes: Why It’s Important to Get Both Right Erin Heckethorn, Director of Compliance, FirstCarolinaCare Insurance Company Alexander Henrichs, Aon
    • Best Practices and Unique Perspectives on Root Causes and Developing Corrective Action Plans
    • Why CAPS rely so heavily on Root Causes, and how to help ensure, as Compliance, that you get it right the first time through
    • After the CAP: Measuring and Monitoring results to ensure the Corrective Action is truly Corrective
  • 02:45 PM - 04:15 PM
    P5 Risks and Audit Readiness for NonQuantitative Treatment Limits (NQTLs) of the Mental Health Parity Addiction Equity Act (MHPAEA) Jon Swanson, Senior Compliance Practice Leader, Kaiser Permanente Maggie Russillo, Sr Director, Health Plan Compliance, Washington, Kaiser Permanente
    • Understand the unique health plan challenges posed by MHPAEA nonquantitative treatment limits (NQTLs) in order to facilitate operational engagement
    • Address regulator, purchaser, and member expectations of NQTLs
    • Learn to build a toolkit to complete meaningful assessments and evaluate compliance for audit readiness
  • 04:15 PM - 06:00 PM
    Welcome Reception with Exhibitors

Monday, February 1

  • 07:00 AM - 08:00 AM
    Breakfast with Exhibitors
  • 08:00 AM - 08:15 AM
    Welcome & Opening Remarks
  • 08:15 AM - 09:15 AM
    GENERAL SESSION Medicaid Fraud Trends & Best Practices for Reporting and Partnering with State Medicaid Regulators Gary Cantrell, Deputy Inspector General for Investigations, OIG HHS Marita Janiga, Executive Director, Investigations, Kaiser Permanente
    • Emerging Medicaid fraud risks and areas of interest to Managed Care Professionals.
    • Partnering with your Medicaid fraud control teams and best practices for reporting suspected fraud.
    • Preparing for Medicaid audits to achieve successful outcomes
  • 09:15 AM - 09:45 AM
    Networking Break
  • 09:45 AM - 10:45 AM
    Breakout Sessions
    #101
    101 Integrated Appeals and Grievances: A Roadmap for D-SNPs Sarah Swank, Counsel, Nixon Peabody Justin Frazer, Director, Regulatory Compliance, Mazars USA LLP
    • Per CMS requirements, by 2021, D-SNPs must be prepared to deliver to its beneficiaries a fully integrated (Medicaid and Medicare) appeals and grievance model.
    • State agencies have already proposed various models of integration to CMS that D-SNPs are or will be required to implement, operationalize and monitor to ensure that mandated benchmarks meet the revised regulatory standards.
    • As most integrated models are similar in scope and delivery, this presentation will offer common suggestions on how D-SNPs can update their operational models, member notifications and materials, corporate policies as well as other assurances of compliance.
    Intermediate
    #102
    102 What You Don’t Know Will Hurt You: Managed Care Enforcement Trends and Key Risk Areas John Kelly, Member, Bass, Berry & Sims PLC Benjamin Singer, Partner, O’Melveny & Myers LLP Megan Tinker, Senior Advisor for Legal Affairs, HHS-OIG
    • The panel will review in detail and discuss lessons learned from past cases and current enforcement trends against Medicare and Medicaid Managed Care organizations and providers.
    • The panel will identify key risk areas and best practices to minimize exposure.
    • The panel will discuss how compliance program deficiencies in the risk adjustment space can create enforcement risk.
    Intermediate
    #103
    103 Privacy Compliance Challenges in a Crisis and How to Integrate with SOC2 Requirements Gregory Vetter, Director, McGladrey LLP, CPA Douglas Underwood
    • Learn about trends and best practices in privacy compliance during the current crisis and how to apply them for future events
    • Understand the Service Organization Control (SOC2) audit framework and trends
    • Utilize SOC2 and other frameworks to ensure your organization is identifies, monitors, and reports on the key and shifting compliance risks within the changing environment
    Intermediate
  • 10:45 AM - 11:15 AM
    Networking Break
  • 11:15 AM - 12:15 PM
    Breakout Sessions
    #201
    201 Another Look at Building a DSNP Compliance Program Kimulet Winzer, Director, SunHawk Consulting Nicole Larson, Chief Compliance Officer, Steward Health Choice Arizona
    • How to move from building to implementing a DSNP Compliance program - compliance professionals will share pitfalls and best practices
    • Components and concepts to create an effective program
    • How compliance professionals engage stakeholders as partners in building and creating an effective DSNP program
    Intermediate
    #202
    202 Successful Regulatory Relationships Post-COVID-19 with Sponsors and FDRs Robert Alfano, Director of Compliance Services, Prime Therapeutics LLC Kenneth Nunez, Vice President, Compliance Solutions, ATTAC Consulting Group
    • Changes from COVID-19 on the regulatory relationship: more virtual, government has less resources, more expectations on Health Plans to comply and step up, more regulator sensitivity to CTMs due to beneficiary financial issues
    • Changes to Health Plan workforce: More remote- how to reach, teach, and enforce compliance in virtual settings, privacy issues, and security of data/workspaces in the "new normal"
    • Impacts to daily work and operations: FDRs impacted by shifting supply chain dynamics, applicability of COVID-19 additional and evolving regulations, and how to operationalize them in this new dynamic
    Advanced
    #203
    TBA Douglas Underwood
  • 12:15 PM - 01:15 PM
    Lunch (provided)
  • 01:15 PM - 02:15 PM
    Breakout Sessions
    #301
    301 Preparing for the Era of Provider Network Transparency John Weis, President and Co-Founder, Quest Analytics Michael Adelberg, Principal, Faegre Baker Daniels
    • Across health care there is a growing need to measure, manage, and improve provider directories - a need driven by regulators and market driven innovations.
    • Find out how regulators and members depend on provider directories, why directories are frequently inaccurate, and what new tools and approaches exist to improve their accuracy.
    • Gain an understanding of why provider directories are increasingly used to measure network adequacy in real time and for determining network capacity and stability.
    Intermediate
    #302
    302 Preparing Effective Corrective Action Plans: Get to the Root! Thomas Wilson, VP Compliance Officer, Health Team Advantage Tammy Mosely, Senior Compliance Manager, Care N' Care of North Carolina
    • CMS expects health plans to develop corrective action plans in response to noncompliance or fraud, waste and abuse issues. Developing effective corrective action plans generally includes root cause and impact analyses. What does this really mean?
    • The presentation will cover CMS expectations - Resolve, Prevent, Monitor. Root Cause Analysis - Why? Impact Analysis - Who? Corrective Action Plan (CAP) - What do we do? *Actions Taken *Testing *Implementation *Monitoring.
    • The presentation will explore the end-to-end process with an interactive case study to demonstrate critical steps. Polling questions will be used. y Tools and resources will be provided to develop CAPs that can withstand CMS scrutiny.
    Basic
    #303
    303 Best Practices in Board, Compliance Committee, and CEO Reporting Laurena Lockner, Sr Mgr Monitoring & Compliance, HealthPartners Steve Bunde, VP Integrity & Compliance & Internal Audit, HealthPartners
    • Learn about Board and Compliance Committee Oversight Responsibilities
    • Understand Best Practices in Reporting
    • Develop Agendas, Tools, and Templates for Reporting
    Intermediate
  • 02:15 PM - 02:45 PM
    Networking Break
  • 02:45 PM - 03:45 PM
    Breakout Sessions
    #401
    401 Not for the Faint of Heart: The Path to Compliance amid Medicaid Expansion Chris Zitzer, VP, Chief Compliance & Ethics Officer, UCare Minnesota
    • From Medicaid expansion to COVID-19, expectations of state Medicaid agencies continue to evolve at a rapid pace.
    • Top compliance issues facing Medicaid Compliance Officers.
    • How to adjust your Medicaid Compliance Program in light of the rapidly changing environment.
    Intermediate
    #402
    402 Social Determinants of Health: Minimizing Compliance Challenges While Implementing a Data-Driven and Collaborative Approach to Improve Community Health Maureen Hydok, Senior Director Healthcare, Huron Consulting Group Maureen Hydok, Senior Director Healthcare, Huron Consulting Group
    • Understand Social Determinants of Health (SDoH) & how addressing these factors can improve health/wellness and reduce medical costs
    • Learn how organizations/communities are working together to positively impact overall community and population health with collaborative SDoH solutions
    • Recognize regulatory and compliance challenges when leveraging SDoH data in your strategy
    Intermediate
    #403
    403 Virtual Health Care: Oversight and Opportunities in This New World Anne Crawford, Director, ATTAC Consulting Group LLC Jennifer Del Villar, Dir Gov Pgms Compliance, Cambia Health Solutions, Inc. Annie Shieh, Sr Compliance Counsel, Central Health Plan of California
    • Emerging regulatory landscape and impact on health plan operations and compliance
    • Risks and rewards from health plan, member and provider perspectives
    • Strategies for effective due diligence
    Intermediate
  • 03:45 PM - 04:00 PM
    Networking Break
  • 04:00 PM - 05:00 PM
    GENERAL SESSION Managed Care Compliance Hot Topics Panel Carolyn Barton, VP, Compliance & Regional Compliance Officer, Kaiser Foundation Health Plan of Washington
  • 05:00 PM - 06:15 PM
    Networking Reception with Exhibitors

Tuesday, February 2

  • 07:00 AM - 08:00 AM
    Breakfast with Exhibitors
  • 08:00 AM - 08:15 AM
    Welcome & Opening Remarks
  • 08:15 AM - 09:15 AM
    GENERAL SESSION Managed Care: OIG Priorities and Identified Risk Areas Megan Tinker, Senior Advisor for Legal Affairs, HHS-OIG
    • Risks areas and enforcement trends
    • OIG priorities and up-coming work in managed care
    • Flexibilities and changes as a result of COVID-19
  • 09:15 AM - 09:45 AM
    Networking Break
  • 09:45 AM - 10:45 AM
    Breakout Sessions
    #501
    501 CMS Universes: Using Regulatory Data Sets to Provide Monitoring and Oversight to Inform Decision Making Melissa Hecht, AVP, Operations & Business Continuity Director, Healthfirst. Inc. Adam Zeldin, Senior Associate, PricewaterhouseCoopers
    • Implement a universe monitoring program to identify key risks related to operational inefficiencies (e.g. lack of provider outreach) and adjust staffing and processes to meet compliance and operational needs
    • Proactively improve operational and compliance performance to save cost
    • Leverage data quality monitoring program to identify third-party vendors with quality and process gaps needing remedial actions
    Intermediate
    #502
    502 Compliance Organizational Design Veronica Moore, Director, Corporate and Medicare Compliance, BCBS of AZ James Rose, Managing Director, SunHawk Consulting LLC
    • What considerations should be made for organization design of the compliance program?
    • How does my organization’s internal audit, enterprise risk management, privacy, cyber security, ethics, human resources areas impact the compliance organization design?
    • What is organizational design and how it is important to compliance program effectiveness?
    Intermediate
    #503
    503 Federal and State-Based Exchanges: Risk Reduction Strategies Steve Bunde, VP Integrity & Compliance & Internal Audit, HealthPartners
    • Understand key compliance requirements for exchange-based products
    • Identify key risks areas for your exchange-based products
    • Develop a risk assessment and proactive monitoring plans to reduce compliance risks
    Intermediate
  • 10:45 AM - 11:15 AM
    Networking Break
  • 11:15 AM - 12:15 PM
    Breakout Sessions
    #601
    601 Building an Audit-Ready Pharmacy Compliance Program Katherine Tarvestad, VP of Compliance, Medicare and Retirement, United Health Care Niki Jo Kurtis, Pharmacy Compliance Officer, UnitedHealthcare
    • How can business owners and Compliance partner to achieve greater outcomes?
    • Practical tips for assessing key Compliance risks in your Pharmacy program
    • Building a Regulatory Audit Readiness Strategy
    Intermediate
    #602
    602 The Risks of Risk Adjustment Reviews: Enforcement Trends and Litigation Involving Medicare Advantage Risk Adjustment Practices Rachel Alexander, Partner, Wiley Brandon Moss, Attorney, Wiley Rein
    • In the last year, DOJ has proclaimed Medicare Advantage to be a prime enforcement target.
    • While DOJ has suffered setbacks, they are primed to attack Medicare Advantage providers’ practices with respect to auditing or reviewing risk adjustment scoring - both civilly and criminally.
    • This panel will discuss recent enforcement trends, where courts are lining up on interpreting key regulations, and what all this means for Medicare Advantage providers looking to navigate this high-stakes and ever-changing landscape.
    Intermediate
    #603
    603 Implementing Regulatory Changes: A "How-To Guide" for Any Organization of Any Size Angela Keenan, Director, Compliance & Privacy, Network Health Jessica VanderZanden, VP, Compliance and Culture, Network Health
    • In a world of constantly changing regulations, learn best practices regarding interpretation, breaking down and facilitating required actions.
    • Discuss tips, tricks and tools for partnering with business areas on regulatory changes while keeping on track with complicated regulations that span long periods of time.
    • Once changes are implemented, explore ways of ensuring continued compliance and effectiveness with the changes.
    Basic
  • 12:15 PM - 01:15 PM
    Lunch & Last Chance to Visit Exhibitors
  • 01:15 PM - 02:15 PM
    Breakout Sessions
    #701
    701 The Auditors Are Coming: Is Your Medicaid Managed Care Health Plan Ready? Holly Dolgaard, Principal, Mercer Scott Banken, Principal, Mercer Chris Babcock, Consultant, Mercer
    • The Medicaid Managed Care Final Rule requires state Medicaid agencies to complete an independent audit of the accuracy, truthfulness, and completeness of the encounter and financial data submitted by each MCO every 3 years.
    • Learn key financial concepts that drive rate setting, risk adjustment, and medical loss ratio processes and their connection to financial and encounter data. Review tools and resources that encounter data validation auditors utilize.
    • The COVID-19 pandemic response included special procedure codes, diagnoses, and modifiers for testing, treatment, and other healthcare impacted by COVID-19. Learn steps to ensure your encounters accurately reflect the impact of COVID-19.
    Intermediate
    #702
    702 Compliant Coding Review Project Management: From Project Concept to Analyzing Rev Dott Campo, Manager, Risk Adjustment Division, Reimbursement Mgmt Consultants, Inc. Rebecca Welling, Senior Director- Coding Compliance, Providence Health Plan Dana Brown, President, Reimbursement Mgmt Consultants, Inc.
    • Project Management is Key in overall success of a Coding Review Project. This presentation will review the key steps one should take to ensure the review performed will garner useful information once completed.
    • Compliance is a necessity in performance of any coding review. Risk Adjustment poses compliance/privacy/security risks not seen in other reviews. This presentation will highlight common issues and best practices.
    • Staff, Talent and Tools are critical to any project success. This presentation will address best advice and practices in these areas.
    Intermediate
    #703
    703 Cyber Risk = Disruptive Business Risk Uday Ali Pabrai, CEO, ecfirst
    • Examine how to establish an audit-ready compliance program.
    • Analyze critical areas to address in an enterprise security plan.
    • Check ransomware, phishing, DoS, DDoS that can seriously disrupt business processes and priorities.
    Basic
  • 02:15 PM - 02:45 PM
    Networking Break
  • 02:45 PM - 03:45 PM
    Breakout Sessions