#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 View Description

• 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 View Description

• 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

#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 View Description

• 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 View Description

• 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

#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 View Description

• 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 View Description

• 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

#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 View Description

• 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 View Description

• Update on recent changes to health information privacy laws
• Recent privacy and security enforcement trends
• Third party risk assessment

Intermediate