Internal Investigation Overpayment and Self-disclosure Gabriel Imperato, Managing Partner, Nelson Mullins Riley & Scarborough Dwight Claustre, Retired Compliance Professional

• Authority and practical considerations for conducting internal investigations
• Procedures and best practices for internal investigations
• Evaluation and report and potential selfdisclosure

Break

Criminal and Civil Liability and Medical Necessity Rosalind Cordini, Senior Vice President, Coding & Compliance Services, Coker Group Deanna Nicolozakes, Director, Compliance, Jackson Health System

• What medical necessity means and how it is established
• How medical necessity cases are enforced and the primary factors for distinguishing a civil medical necessity case from a criminal case
• Do robust compliance measures prevent medical necessity cases, and how to respond when a medical necessity matter arises within your organization

Break

Compliance Experts and Compliance Program Effectiveness Judy Ringholz, Founder and Principal, Sage Compliance Advisors, LLC Felicia Heimer, Senior Counsel, Office of Counsel To the Inspector General, U. S.

• What to ask and look for in effectiveness evaluation proposals
• Things to consider as your effectiveness review is being conducted
• Using review results to improve your compliance program’s performance

Lunch (provided)

Criminal and Civil Enforcement and Telehealth Raul Ordonez, Vice President & Chief Compliance Officer, Jackson Health System Jonathan Porter, Partner, Husch Blackwell

• Telemedicine fraud and enforcement efforts by DOJ and HHS-OIG
• COVID-19 fraud schemes: Examples and warning signs
• Genetic testing, urine drug testing and other lab fraud schemes

Break

Privacy Breach through the Eyes of a Business Associate Judy Ringholz, Founder and Principal, Sage Compliance Advisors, LLC Blaine Kerr, AVP, Deputy Chief Privacy Officer, Ensemble Health Partners

• Recognize the importance of establishing communication with the Covered Entity’s Privacy Office at or near the time the Business Associate Agreement is signed
• Identify what obligations and tasks the Business Associate may have as part of the Privacy Breach Response
• Learn the basics of providing comprehensive, accurate and timely reports to the Covered Entity

Break

Recent Developments in Kickback and Stark Law Robert Wade, Partner, Nelson Mullins Riley & Scarborough LLP Brian McEvoy, Partner, Baker Hostetler

• Overview of Anti-Kickback or Stark Law developments and settlements
• Summary of recent regulatory developments including value-based payment arrangements
• Review and developments in all-payer kickback statue (EKRA 2018)