Sunday, February 22
Pre-Conference

8:00 – 10:00 am

P1 Effective Self-Disclosure

Matt Weber, Partner, Holland & Hart LLP
Gregory J. Wellins, Senior Counsel, Office of Counsel to the Inspector General, U.S. Department of Health and Human Services

Handout 1, Handout 2, Handout 3, Handout 4

• The benefits of encouraging compliance self-reports within the organization
• The risks and benefits of self-disclosure to governmental authorities
• How self-assessment investigations are conducted
• How to position a self-disclosure for a favorable outcome

10:15 am – 12:00 pm

P2 Development of a Compliance Plan

Ellen M. Hunt, JD, Vice President–Compliance Operations, Vice President–Compliance Officer, HCSC Insurance Services Company Health Care Service Corporation
Judith Nelson, Vice President and Chief Compliance Officer, BlueCross BlueShield of Tennessee

Handout 1

1:30 – 3:30 pm

P3 Training for the Workforce and the Use of Technology

Brett Curran, Vice President GRC and Regulatory Practices, Axentis, Inc.
Dorothy DeAngelis, Managing Director/Forensic and Litigation Consulting, FTI

Handout 1

3:45 – 5:45 pm

P4 Medicare D 101

Dorothy DeAngelis, Managing Director/Forensic and Litigation Consulting, FTI
Richard Merino, Director–Forensic and Litigation Consulting, FTI

Handout 1

• Overview and background of program, including new MIPPA changes*
• Enrollment & Disenrollment rules
• Marketing Guidelines
• Low Income Subsidy (LIS) Provisions
• PBM Delegation & Oversight
• Compliance Plan & Fraud, Waste and Abuse Plan

* Newly released provisions and upcoming regulations from the Medicare Improvement for Patients & Providers of 2008 (MIPPA) will be integrated into this presentation

Monday, February 23
Conference

8:00 – 9:15 am

General Session:
Modeling Compliance: The New Model Managed Care Compliance

Carol Booth, RN/Auditor, Managed Care, New York Office of the Medicaid Inspector General
Patrick Dufresne, Director, Bureau of Managed Care & Provider Review, New York Office of the Medicaid Inspector General

Handout 1

• The first public Medicaid managed care compliance guidance since 2002, which is expected to be a state and national model
• The use of data mining and data analysis techniques by state Medicaid agencies in reviewing billing and recovering payments to Medicaid managed care plans
• Approaches and impediments to assuring provision of more current and accurate information used in billing and payment to and from managed care plans

9:30 – 10:45 am

General Session:
Hot Topics from the Centers for Medicare and Medicaid Services

Kim Brandt, Director Program Integrity Group, Center for Medicare and Medicaid Services
Brenda Tranchida, Program Compliance and Oversight Group, Center for Drug and Health Plan Choice, Centers for Medicare and Medicaid Services

Handout 1, Handout 2

11:00 am – 12:00 pm
Breakout Sessions

101 Risk Assessment: The Good, the Bad, and the Ugly

Steve Bunde CPA, CFE, CHC, Sr. Director of Corporate Integrity & Internal Audit, Health Partners
Deb Ziegler, Corporate Compliance Officer, Capital Blue Cross

Handout 1

• Warning…risk assessments can be hazardous to your health (or is that your wealth)
• Risk Assessment tools—some favorites…to some not so favorites
• Monitoring Risks— tools for every purpose

102 Preventing and Responding to Data Breaches

Anne Doyle, Executive VP/Chief Compliance Officer, Fallon Community Health Plan

Handout 1, Handout 2, Handout 3, Handout 4, Handout 5, Handout 6, Handout 7, Handout 8

• Extent of the challenge
• Best practices to secure data and prevent a breach
• Responding and doing the right thing
• Notification requirements: who, what, when?

12:00 – 1:00 pm
Networking Lunch

1:00 – 2:00 pm
Breakout Sessions

201 Regulatory Reports and Submissions: Just What Are You Sending To Your Customer?

Gary Fitzgerald, Director Compliance & Regulatory Affairs, Harmony Health Plan of IL, Inc.

Handout 1

• Purpose and function of reporting
• Risks of a poor reporting program
• Things you need to know about your reports
• Establishing an effective reporting program

202 Effectively Structuring a Strong Fraud, Waste, and Abuse Program

William Gedman, VP Audit, Fraud & Abuse UPMC Health Plan

Handout 1

• Prevention and detection elements
• The make-up of the Special Investigations Unit is of vital importance
• Compliance training for employees, providers, members, and vendors
• Identification of risks is essential, and should be done on a routine basis
• The SIU should partner with other health plan operating departments, the pharmacy benefits manager, and others to be most effective
• Data analysis related to F&A detection is complex, but necessary for success

Monday, February 23
Conference continued

2:15 – 3:15 pm
Breakout Sessions

301 Information Security for Health Plans

Jeannette Frey, Privacy Officer, Fallon Community Health Plan

Handout 1

• Summary of the regulatory landscape and applicability to health plans—e.g. HIPAA Security, Medicare Advantage/CMS Regulations and guidance, State security breach notification laws, Payment Card Industry (PCI) Standards
• Discussion of recent enforcement activities and heightened level of scrutiny
• Risk areas and challenges
• Integration with privacy and compliance programs

302 Oversight of Your Vendors for Medicare Advantage and Part D Business

Annmarie Gover, Medicare Compliance Officer, Capital BlueCross

Handout 1

• What oversight does CMS expect?
• Discussion of vendor contract provisions to protect your Plan for vendor’s failure to perform or perform satisfactorily
• Plan oversight of vendors—what works and what doesn’t

3:30 – 4:30 pm
Breakout Sessions

401 Medicare Advantage and Part D Compliance Best Practices

Handout 1

Tom Bixby, Partner, Neal, Gerber & Eisenberg LLP

• Best practices and lessons learned during a comprehensive assessment in preparation for Part D compliance program implementation
• Learn to assess and improve Medicare Part D and Medicare Advantage compliance programs and identify strategies for coordinating with various stakeholders including a plan’s overall compliance program

402 Medicaid Managed Care: Creating and Managing Effective Compliance Programs Including Compliance Auditing and Responding to Managed Care Fraud

Clifford E. Barnes, Esq., Member of the Firm, Epstein Becker & Green, P.C.
Elizabeth Browning, CHC, PCA, Medicare Compliance Officer, Blue Cross Blue Shield of Rhode Island

Handout 1, Handout 2

• Essential elements of an effective compliance program
• Key Medicaid risk areas
• Conducting internal audits
• Anatomy of an investigation around managed care

Tuesday, February 24

8:15 – 9:15 am

General Session:
Office of the Medicaid Inspector General Compliance Guidance for Medicaid Managed Care

Jim Sheehan, Medicaid Inspector General, New York State Office of the Medicaid Inspector General

Handout 1

9:30 – 10:30 am

General Session:
The Top Ten Compliance Challenges for Managed Care Plans

Kirk Nahra, Partner, Wiley Rein LLP

Handout 1

• This program will address the top compliance challenges for managed care plans, including
• the most recent developments in health care investigations
• the key risk areas for managed care companies and
• the most significant areas for new attention in your compliance program
  

10:45 – 11:45 am
Breakout Sessions

501 Compliance and Your Health Plan Sales

Lori Dutcher, Vice President Compliance MSSA, Kaiser Foundation Health Plan

Handout 1

• Broker Compliance issues
• Sales Privacy and Security Issues
• Risk Mitigation with your sales staff
• Strategies for engaging health plan sales staff in your compliance program

502 Compliance, Internal Audit, and Legal:
An Independent, Integrated Approach

Rebecca Learner, Senior VP & Compliance Officer, SCAN Health Plan

Handout 1

• When compliance, internal audit, and legal are independent of each other, a set of integration activities is necessary so all three departments can operate effectively and serve the Board appropriately
• Review ways that you can implement these integration activities in your organization

11:45 am – 1:00 pm
Networking Lunch

1:00 – 2:00 pm
Breakout Sessions

601 Plans and Involving the Board

Dan Garcia, Senior Vice President, Kaiser Permanente

Handout 1

602 Mind Your Own Business…Associates: Detailed Guidance For Creating and Implementing a Successful Business Associate Assessment Program

Sharon A. Anolik, Director, Corporate Compliance and Ethics, Chief Privacy Official, Blue Shield of California

Handout 1

• Help bring the audience to the next level of awareness and responsibilities regarding HIPAA privacy compliance relating to Business Associates
• Provide concrete examples and advice on how to perform Business Associate assessments
• Provide details on how to conduct the actual assessment and post-assessment work
• Include tips for those who already have a working business associate assessment program
  yyHighlight the best practices for protecting information when working with vendors located offshore

2:15 – 3:15 pm
Breakout Sessions

701 Medicare Advantage and Part D Oversight Activities: A Health Plan Perspective

Kim Green, Compliance Officer, Blue Cross and Blue Shield Northern Plains Alliance
Sandra Miller, Director of Government Compliance, Blue Cross Blue Shield of Minnesota

Handout 1

• Overview of CMS strategies for plan oversight
• Discussion of plan monitoring and readiness activities
• Plan perspective on a CMS audit experience

702 Key Litigation Risks for Health Plans

Rick Shackelford, Partner, King & Spalding, LLP

Handout 1, Handout 2

• Major litigation issues for health plans
• Issues of most relevance to compliance personnel
• Implications for compliance programs and personnel