January 30 - February 1, 2022
2022 Managed Care Compliance Conference
Phoenix, AZ, United StatesAgenda
Sunday, January 30
-
08:00 AM - 09:30 AMP1 - Diversity, Equity, and Inclusion in the Compliance Space Cheyenne Ross, Arizona VP of Compliance & Regulatory Affairs, Arizona Complete Health Kimulet Winzer, Director
- Increase compliance program engagement by intentionally creating an inclusive environment
- Expand leadership skills by leveraging inclusive language to foster ethical decisions
- Learn to infuse courageous conversations and ongoing training to strengthen your compliance program
Intermediate -
09:30 AM - 09:45 AMNetworking Break
-
09:45 AM - 11:15 AMP2 - Mental Health Parity and Addiction Equity Act (MHPAEA): Compliance in Action Noreen Vergara, Senior Counsel, Husch Blackwell LLP Zach Davis, Senior Consulting Actuary, Wakely Consulting Group, LLC Amanda Brown, Vice President, Compliance Solutions, ATTAC Consulting Group LLC
- Quantitative treatment limitations (QTL) and Non-quantitative treatment limitations (NQTL) 101
- Creating a QTL annual testing process, NQTL comparative analysis, and compliance oversight program
- The latest MHPAEA-related regulatory updates and their impact on compliance and the industry
Intermediate -
11:15 AM - 12:45 PMLunch (on your own)
-
11:30 AM - 12:30 PMSpeedNetworking (Lunch provided only for pre-registered participants)
-
12:45 PM - 02:15 PMP3 - Applying the Seven Elements of an Effective Compliance Program for Best Practices in Regulatory Audits Kenneth Nunez, Chief Compliance Officer, Provider Partners Health Plans Annie Shieh, Sr Compliance Counsel, Central Health Plan of California Robert Alfano, U.S. Regulatory Lead, Babylon
- Apply the seven elements into regulatory audit planning to manage toward successful results
- Discuss key regulatory audit prep best practices using the seven elements to guide successful planning, ensure cohesiveness, and organization in audit prep
- This presentation will present best practices from a plan, PBM, and TPA oversight perspective and discuss how this effective planning can help better organize your regulatory audits
Intermediate -
02:15 PM - 02:30 PMNetworking Break
-
02:30 PM - 04:00 PMP4 - Back to the Future: Leveraging Knowledge and Experiences to Accommodate 2022 CMS Program Audit Protocols Anne Crawford, Director, ATTAC Consulting Group LLC Annie Shieh, Sr Compliance Counsel, Central Health Plan of California
- Hear how recent audit experiences combined with revised CMS program audit protocols can be leveraged
- Key considerations when determining if 2022 protocols require modifications to monitoring activities
- Applying best practices to ensure audit readiness
Intermediate -
04:00 PM - 05:30 PMWelcome Reception
Monday, January 31
-
07:00 AM - 08:00 AMContinental Breakfast
-
08:00 AM - 08:15 AMOpening Remarks
-
08:15 AM - 09:15 AMGeneral Session - Managed Care: OIG Update on Priorities and Risk Areas in Managed Care Megan Tinker, Assistant Inspector General, HHS-OIG
- Discussion of recent OIG work in managed care
- Risk areas and enforcement trends
- Upcoming OIG work and priorities in managed care
-
09:15 AM - 09:45 AMNetworking Break
-
09:45 AM - 10:45 AMBreakout Sessions#101101 - Effective and Compliance HCC Capture Auditing Allison Ritchie, Manager, Protiviti Kim Pardini-Kiely, Clinical and Operational Excellence Lead, Protiviti Bryan Beaudoin, Health Information Management Solution Lead, Protiviti
- Receive an overview of hierarchical condition category (HCCs) capture's importance and use
- Learn how to use data analytics to effectively audit HCC capture for accuracy and compliance
- Understand how to oversee a risk-based HCC capture audit as well as integrating internal controls
Intermediate#102102 - Surprises in the No Surprises Act: New Requirements for Plans and Providers Regarding Provider Directory Information Michael Adelberg, Principal, Faegre Drinker Consulting Scott Westover, SVP Network and Regulatory Strategy, Quest Analytics- In order to improve the accuracy of provider directories, Congress passed the No Surprises Act
- The No Surprises Act puts new requirements on new health plans and providers
- Health plans and providers have to come into compliance with the law and new regulation
Intermediate#103103 - Fraud, Waste and Abuse Updates from the FBI Joseph Parker, Supervisory Special Agent, Department of Justice, Federal Bureau of Investigation- Discussion of the FBI’s Health Care Fraud Program initiatives and priorities
- Review of current and emerging health care fraud schemes
- How the FBI works with other Federal agencies and private insurance carriers
Intermediate -
10:45 AM - 11:00 AMNetworking Break
-
11:00 AM - 12:00 PMBreakout Sessions#201201 - Best Practices in Establishing a Medicare Drug Management Program to Ensure Quality and Compliance Dawn Becker-Ellison, Sr Clinical Pharmacist, Blue Shield Of California Amy Togonon, Clinical Pharmacist, Blue Shield of California
- Review Medicare Part D requirements for a Drug Management Program
- Describe case review team membership and process
- Describe how the team and processes ensure compliance with Medicare DMP requirements
Basic#202202 - Compliance Considerations in Mergers and Acquisitions Jenny O'Brien, Retired, Chief Compliance Officer Steve Lokensgard, Partner, Faegre Drinker Biddle & Reath- Reviewing pre-delegation and contracting requirements
- Role in due diligence reviews
- Integration strategies
Intermediate#203203 - Compliance Organization Design James Rose, Managing Director, SunHawk Consulting LLC- What is organizational design and how it is important to compliance program effectiveness?
- How does my organization's other governance groups impact the compliance organization design?
- What considerations should be made for organization design of the compliance program?
Intermediate -
12:00 PM - 01:15 PMLunch (Dessert in exhibit hall)
-
01:15 PM - 02:15 PMBreakout Sessions#301301 - Compliance Issues Under the Purview of Payment Integrity and Fraud, Waste, and Abuse Karen Weintraub, Executive Vice President, Healthcare Fraud Shield Lori Peters, Sr. Director SIU, Centene Corporation
- How to quickly identify providers and beneficiaries improperly enrolled
- Utilizing analytics to capture providers billing multiple products for the same beneficiaries
- Using public record data in your PI/FWA program to identify exclusions, adverse actions, and more
Intermediate#302302 - OCR Updates Alicia Brown, Supervisory Equal Opportunity Specialist, DHHS/OCR Pacific Region- OCR policy updates: Proposed modifications to the HIPAA Privacy Rule; HIPAA and COVID-19 updates; notification of enforcement discretion on telehealth remote communications; guidance on disclosures to law enforcement, other first responders, etc.
- Breach highlights and recent enforcement activity
- General HIPAA enforcement update
Basic#303303 - The Lifecycle of a CMS Part D Memo from Analysis to CMS Audit Maggie Perritt, Compliance Officer Mark Horowitz, Sr. Manager National Special Investigations Unit, Kaiser Permanente Tamara Neiman, Executive Director, Nat'l Special Investigations Unit, Kaiser Permanente- We will describe the process from cradle to grave using an actual I-MEDIC referral that was initiated from a CMS Quarterly Drug Trend Analysis Memo
- We will present how data visualization identified the issue, how clinical review confirmed the issue, and the role played by the SIU in referring the matter to the I-MEDIC
- During a recent CMS audit this case was selected as the Tracer. During the presentation, we will outline our documentation process for the Tracer and discuss the outcome
Intermediate -
02:15 PM - 02:30 PMNetworking Break
-
02:30 PM - 03:30 PMBreakout Sessions#401401 - TBAIntermediate#402402 - The Next Big Thing! Maintaining Compliance and Managing Risk with Healthcare Startup Vendors and Providers Sandra Durkin, Member Attorney, Strategic Health law Elizabeth Lippincott, Managing Member, Strategic Health Law
- Legal risks of contracting with startup and private equity-backed companies, which can help health plans stay competitive with their innovation but may also pose risks to compliance and overtax your plans legal and compliance resources
- Handling vendor negotiations with a company that lacks expertise in the healthcare legal and regulatory environment, including anti-fraud laws, such as the Anti-Kickback Statute, that can be violated during the negotiation process
- Practical strategies for counseling internal business clients on challenges unique to dealing with healthcare startups, including ongoing compliance monitoring of organizations with limited internal legal and compliance resources
Intermediate#403403 - OIG Audits of Diagnosis Codes at High Risk for Being Miscoded: A Discussion of How We Identify Diagnosis Codes to Audit and What You Can Do to Enhance Your Compliance Procedures Chris Bresette, Director, Medicare Part C Audits, Dept. of HHS, OIG, Office of Audit Services Nicole Hackenmiller, Sr Auditor, Dept. of HHS, OIG, Office of Audit Services- The panel will talk about how the OIG combines data-mining techniques and discussions with medical professionals to identify diagnosis codes to audit
- The panel will discuss how the OIG's audits have evolved
- The panel will discuss how MA organizations can increase their compliance program’s effectiveness when detecting and correcting inaccurate diagnosis codes
Intermediate -
03:30 PM - 03:45 PMNetworking Break
-
03:45 PM - 04:45 PMGeneral Session: The Dos and Don't of Medicare Advantage and Medicaid Managed Care: Lessons from Recent Enforcement Activity Katherine Armstrong, Assistant United States Attorney, United States Attorney's Office Pamela Brecht, Attorney/Partner, Pietragallo Gordon Alfano Bosick & Raspanti, LLP Jon Ferry, Partner, Government Enforcement & Investigations, Bradley Arant Boult Cummings
- Participants will gain understanding of Medicare Programs and the Risk Adjustment Process
- Participants will gain understanding of Medicaid Managed Care Program Risk
- Participants will gain understanding of the current enforcement environment in Medicare Advantage and Medicaid Managed Care
- Participants will get takeaways from recent enforcement activity to help improve compliance programs
-
04:45 PM - 06:00 PMNetworking Reception
Tuesday, February 1
-
07:00 AM - 07:55 AMContinental Breakfast
-
07:55 AM - 08:00 AMOpening Remarks
-
08:00 AM - 09:00 AMGeneral Session: Why Me? Compliance Officer’s Personal Risks in Managed Care Investigations: Liaison, Witness, Subject, Defendant, Whistleblower James Sheehan, Chief, Charities Bureau, NY Attorney General Lisa Estrada, Senior Vice President and Chief Compliance Officer, LifePoint Health
- Understand your potential personal involvement as a compliance officer in government investigations
- Evaluate compliance officer's rights and risks as witness, subject, defendant, or whistleblower
- Learn best practices for addressing involvement in government and whistleblower cases
-
09:00 AM - 09:30 AMNetworking Break
-
09:30 AM - 10:30 AMBreakout Sessions#501501 - The Magic of Universes: Beyond the CMS Audit Gabriel Viola, SVP Customer Relationship, Inovaare Corporation Brenda Wade, Chief Compliance Officer, Inovaare Julie Mason, President, Integritas Medicare
- Leverage universes for operational performance analysis, not merely for CMS Program Audits
- Monitor universes regularly to proactively address and mitigate issues
- Avoid penalties and delays by sustaining continuous compliance, not reacting to audits
Intermediate#502502 - A Deep Dive: Enforcement Trends and Risk Areas in Managed Care Megan Tinker, Assistant Inspector General, HHS-OIG Benjamin Singer, Partner, O’Melveny & Myers LLP John Kelly, Member, Bass, Berry & Sims PLC- The panel will discuss in detail lessons learned from past and current enforcement actions
- The panel will identify key risk areas for Medicare managed care organizations and providers
- The panel will discuss compliance program best practices to minimize risk in Medicare Advantage
Advanced -
10:30 AM - 10:45 AMNetworking Break
-
10:45 AM - 11:45 AMBreakout Sessions#601601 - Preparing MCOs for the IDD Carve-In Anthony Fiori, Senior Managing Director, Manatt Health Justin Frazer, Director, Healthcare Consulting, Mazars USA LLP
- States are increasingly moving individuals with I/DD needs and LTSS services to MCOs
- Some states are creating specialized MCOs, others are relying on existing MCOs
- I/DD needs must be met: CM, waiver service management, network adequacy, and quality measurement
Intermediate#602602 - HITRUST CSF: A Framework of Frameworks Uday Ali Pabrai, CEO, ecfirst- Walk through how HITRUST CSF maps to and addresses CMMC, ISO 27001, HIPAA, and NIST standards
- Evaluate establishing a compliance program on HITRUST CSF
- Examine the prescriptive and scalable requirements of HITRUST CSF
Basic -
11:45 AM - 12:45 PMLunch (Dessert in exhibit hall)
-
12:45 PM - 01:45 PMBreakout Sessions#701701 - Building an Effective Medicare Compliance Risk Assessment Michelle Turano, Vice President Medicare Compliance, Anthem Melissa Whitley, Vice President Client Services, BluePeak Advisors
- Develop effective tools to make tracking and scoring your risks an easier task
- How to collaborate with internal teams to fully identify Medicare risks
- Ensuring effective processes are in place for identifying risks with delegates
Intermediate#702702 - Audit Readiness: To Infinity and Beyond Kim Gray, Manager, Corporate Compliance, Blue Cross Blue Shield of North Carolina Elenor Haith, Director and Corporate Compliance Official, Blue Cross Blue Shield of North Carolina- Integrate an effective compliance risk assessment to reinforce your organization’s audit readiness
- Establish compliance mock audits and assessments that align with regulatory requirements
- Evaluate audit preparedness through readiness checklist activities
Intermediate -
01:45 PM - 02:00 PMNetworking Break
-
02:00 PM - 03:00 PMBreakout Sessions#801801 - De-Delegation: Compliance and Operational Considerations Hannah LaMere, Director, Special Projects, Cody Consulting Group Julie Hughes, Chief Compliance Officer, Cody Consulting Group
- Discuss why plans decide to delegate functions to another entity
- Review scenarios where plans may consider de-delegation and related operational and compliance considerations
- Identify factors to consider when moving a delegated function to another entity or bringing the function in-house
Intermediate#802802 - Automate Your Compliance Process to Impress Regulators John Tanner, Chief Compliance Officer, Beacon Healthcare Systems- Learn how automation can improve your ability to distribute and track HPSM memos
- Understand how automated auditing and monitoring helps you see compliance patterns across your plan
- Apply automation to strengthen compliance oversight and compliance program effectiveness in RADV
Intermediate -
03:00 PM - 03:15 PMNetworking Break
-
03:15 PM - 04:15 PMGeneral Session: Hot Topics Panel Carolyn Barton, VP, Compliance & Regional Compliance Officer, Kaiser Foundation Health Plan of Washington
Wednesday, February 2
-
08:00 AM - 08:15 AMExam Check-In Certified in Healthcare Compliance (CHC)® Exam (Optional) You must apply in advance to sit for the exam. The cost is not included in the conference registration fee.
-
08:15 AM - 10:15 AMCertified in Healthcare Compliance (CHC)® Exam (Optional) You must apply in advance to sit for the exam. The cost is not included in the conference registration fee.
All breakout sessions have a knowledge level associated with them, these levels are just guidelines and you are free to attend sessions of any level.
Basic: Program knowledge level most beneficial to Compliance Professionals new to a skill or an attribute. These individuals are often at the staff or entry level in organizations, although such programs may also benefit a seasoned professional with limited exposure to the area.
Intermediate: Program knowledge level that builds on a basic program, most appropriate for Compliance Professionals with detailed knowledge in an area. Such persons are often at a mid-level within the organization, with operational or supervisory responsibilities, or both.
Advanced: This level focuses on the development of in-depth knowledge, a variety of skills, or a broader range of applications. Advanced level programs are often appropriate for seasoned professionals within organizations, and professionals with specialized knowledge in a subject area.