Agenda

Monday, February 1

  • 09:30 AM - 11:00 AM
    Breakout Sessions
    #P01
    Building and Evolving Your Program Integrity Compliance Program Rick Munson, Program Integrity Chief Compliance Officer & VP Investigations, United Healthcare Michael Jurmu, Associate Director, Compliance, 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
    Intermediate
    #P02
    Covid-19 and Lessons Learned for Flexible Care Management Approaches Rob Parker, Director, PricewaterhouseCoopers Valerie DeBoe, Vice President, Ethics & Compliance, Centene Gretchen Wagner, Risk Management Director, Humana Rohit Gupta, V.P. - Compliance & Medicare Compliance Officer, Molina Healthcare, Inc
    • 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?
    Intermediate
  • 11:00 AM - 11:15 AM
    Coffee Break
  • 11:15 AM - 12:45 PM
    Breakout Sessions
    #P03
    Building a Cybersecurity Auditing and Monitoring Plan Jennifer Griveas, Chief Human Resources Officer & General Counsel, Eliza Jennings Senior Care Network Michael Gray, Vice President of IT and Compliance Officer, Eliza Jennings
    • 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.
    Basic
    #P04
    How to Build a CPE Tracer: Best Practices to Focus on Prevention, Detection, and Correction Using Misclassified Grievances Michelle Larson, Consultant Milly Koranteng, Vice President & Compliance Officer, 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.
    Intermediate
  • 12:45 PM - 01:10 PM
    Mid-Conference Break Activity - Trivia Join fellow attendees in a quick game of trivia! This live, interactive game will test your knowledge and provide a fun activity during the break. See live player rankings and win prizes!
    Sponsored by: ProviderTrust
  • 12:45 PM - 01:30 PM
    Mid-Conference Break
  • 01:30 PM - 03:00 PM
    Breakout Sessions
    #P05
    Risks and Audit Readiness for Non-Quantitative 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 Foundation Health Plan of Washington
    • Understand the unique health plan challenges posed by MHPAEA non-quantitative 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
    Intermediate
    #P06
    Corrective Action Plans & Root Causes: Why It’s Important to Get Both Right 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
    Intermediate
  • 03:00 PM - 03:15 PM
    Coffee Break
  • 03:15 PM - 04:45 PM
    Breakout Sessions
    #P07
    Another Look at Building a DSNP Compliance Program Kimulet Winzer, Director, SunHawk Consulting Nicole Larson, Chief Compliance Officer, Health Choice Arizona Thomas Tutaj, Director of Compliance, WPS Health Solutions
    • 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
    #P08
    The Ever-Evolving Landscape of Privacy and Security Compliance Jonathan Friesen, Chief Privacy Officer, Geisinger Health System Adam Greene, Partner, Davis Wright Tremaine, LLP
    • Update on recent changes to health information privacy laws
    • Recent privacy and security enforcement trends
    • Third party risk assessment
    Intermediate

Tuesday, February 2

  • 08:00 AM - 08:45 AM
    Network & Discussion Groups
  • 08:50 AM - 09:00 AM
    Opening Remarks
  • 09:00 AM - 10:00 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, Vice President, 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 sucessful outcomes
  • 10:00 AM - 10:15 AM
    Coffee Break
  • 10:15 AM - 11:15 AM
    Breakout Sessions
    #101
    101 Integrated Appeals and Grievances: A Roadmap for D-SNPs Sarah Swank, Counsel, Nixon Peabody LLP 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.
    • At the time of this presentation, State agencies have already proposed various models of integration to CMS that D-SNPs will be required to implement, operationalize, and monitor to assure that mandated benchmarks meet the revised regulatory standards.
    • Most integrated models will be similar in scope and delivery; therefore, methods and controls for D-SNPs to update their operational models, member notifications, corporate policies, member materials as well as assurances of compliance will be recommended.
    Intermediate
    #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
    The Workplace of the Future Is Now Suzanne Adnams, Gartner
    • Learn ways to re-create a flexible work policy
    • Consider concepts to rethink functions and redefine expectations
    • Identify and manage challenges related to the new work model
    Intermediate
  • 11:15 AM - 11:30 AM
    Coffee Break
  • 11:30 AM - 12:30 PM
    Breakout Sessions
    #201
    Rewards and Incentives Programs: How to Stay on Top of Innovation and the Regulatory Landscape Vincent Naccarato, Director, Compliance and Counsel, Centene Inc. Tricia Beckmann, Director, Faegre Drinker Tracy Tracy, VP- Compliance and Legal, CCPO, NovuHealth
    • Understand the evolution of rewards and incentives programs in managed care, with a focus on Medicare Advantage and Part D programs and regulatory landscape
    • Gain insights into common and innovative approaches to rewards and incentives offerings in practice today, including CMS demonstration projects
    • Identify how to spot and resolve potential compliance risks before and during implementation through practical tips and best practices
    Intermediate
    #202
    Successful Regulatory Relationships Post-COVID-19 with Sponsors and FDRs Robert Alfano, Compliance Director, Prime Therapeutics Kenneth Nunez, Chief Compliance Officer, Provider Partners Health Plans
    • 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
    Digital Transformation Strategies: Risk & Compliance Considerations Jaime Pego, Managing Director, KPMG LLP Joe Ravas, Director, KPMG
    • How to design a healthcare digital experience strategy
    • Where to start on a digital experience transformation
    • How to avoid potential compliance pitfalls along the way
    Intermediate
  • 12:30 PM - 12:55 PM
    Mid-Conference Break Activity - Trivia Join fellow attendees in a quick game of trivia! This live, interactive game will test your knowledge and provide a fun activity during the break. See live player rankings and win prizes!
    Sponsored by: ProviderTrust
  • 12:30 PM - 01:15 PM
    Mid-Conference Break
  • 01:15 PM - 02:15 PM
    Breakout Sessions
    #301
    Preparing for the Era of Provider Network Transparency John Weis, President and Co-Founder, Quest Analytics Michael Adelberg, Principal, Faegre Drinker Consulting
    • 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
    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
    Basic
    #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 - 02:30 PM
    Coffee Break
  • 02:30 PM - 03:30 PM
    Breakout Sessions
    #401
    Not for the Faint of Heart: The Path to Compliance amid Medicaid Expansion Chris Zitzer, VP, Chief Compliance & Ethics Officer, UCare Susan Anderson, Vice President Corporate Compliance Officer, CareSource
    • 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 considering the rapidly changing environment
    Intermediate
    #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 Marcie Rohleder, Director, Huron
    • 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