Sunday, February 21
Pre-Conference

8:00 – 10:00 am

P1 Building a Successful Compliance Program
for Health Plans

Thomas Figurski, Manager, Special Investigations\Internal Audit, Gateway Health Plan; Melissa Hooks, Gateway Health Plan

Handout 1, Evaluation

• Building a comprehensive compliance plan
  
• Centralizing your organizations compliance efforts
  
• Adapting to changing compliance environment

10:15 am – 12:15 pm

P2 Tackling Health Care Fraud, Waste, and
Abuse – W here Do You Start?

William Gedman, CPA, Vice President, Quality Audit, Fraud & Abuse, UPMC Insurance Services Division; Matthew Weber, Holland& Hart LLP

Handout 1, Handout 2, Evaluation

• Explore current theories regarding the magnitude of
  Health Care FWA
• Identify best practices in establishing a strong FWA unit
  
• Discuss various plan experiences in dealing with the
  challenges of FWA

1:15 – 3:15 pm

P3 Medicare Managed Care: Compliance in an
Era of Health Care Reform

Anne Hance, Partner, McDermott Will & Emery LLP; Robert Slavkin, Senior Counsel, Foley & Lardner LLP

Handout 1, Evaluation

• Overview of health care reform and impact on the
  Medicare Advantage and Part D Programs
• Analysis of new regulations and agency guidance affecting
  the Programs’ participants
• Discussion of industry best practices for key issues,
  including such as marketing and risk adjusters

3:30 – 5:30 pm

P4 Medicaid Managed Care and State
Compliance

Dave Mosley, Principal and Assistant Director, Government Services, Clifton Gunderson LLP; Selvadas Govind, Senior Manager, Assurance Services, Clifton Gunderson LLP

Handout 1, Evaluation

• What states look for from their Medicaid Managed Care Organizations and other Medicaid Contractors
  
• Identify key risk areas in providing Medicaid managed
  care services
  
• Learn what to expect from an audit of the performance of service delivery and accountability

Monday, February 22
Conference

8:15 – 9:00 am

General Session: Hot Topics from CMS

Brenda Tranchida, Director of the Program Compliance and Oversight Group, CMS; Danielle Moon, Director of the Medicare Drug & Health Plan Contract Administration Group, CMS; Cynthia Moreno, Director, Division of Medicare Modernization Act Integrity, Program Integrity Group

Handout 1, Handout 2, Handout 3, Evaluation

9:00 – 9:45 am

General Session: Data Mining

James G. Sheehan, Medicaid Inspector General, NYS Office of the Medicaid Inspector General

Handout 1, Evaluation

10:15 – 11:15 am
Breakout Sessions

101 The Interrelationship among the Compliance Officer, Legal Counsel and the Board of Directors

Cliff Barnes, Partner, Epstein Becker & Green; Marcia Handler, Epstein Becker & Green

Handout 1, Evaluation

• Discuss the individual roles of the three key players and why coordination is necessary
  
• Review when the roles do and do not work and the
  consequences of ill conceived roles
  
• Provide action items that should be considered in
  developing effective roles among the key players

102 Vendor Oversight

Alan Brandon, CHC, Corporate Compliance and Privacy Officer, Director of Compliance, Community Health Plan, Seattle, Washington

Handout 1, Evaluation

• Vendor oversight: know how your dollars are being spent
  
• Delegated vendor oversight
  
• Vendor oversight: ensuring quality and compliance

11:15 am – 12:00 pm
Networking Lunch

12:15 – 1:15 pm
Breakout Sessions

201 Part D:  Compliance Considerations - 4 Years Later!

Caron R. Cullen, CHC, Vice President, Compliance & Regulatory Affairs, Affinity Health Plan; Kara Curtis, Director, Regulatory Affairs& Compliance, Commonwealth Care Alliance

Handout 1, Evaluation

202 Current Antitrust Issues for Managed Care
Plans

John J. Miles, Principal and Shareholder, Ober/Kaler

Handout 1, Handout 2, Evaluation

• The Administration’s approach toward managed care
  antitrust issues
  
• Issues, including mergers, exclusionary contracts, most favored-nations, and all-products provisions
  
• Minimizing antitrust risk

1:45 – 2:45 pm
Breakout Sessions

301 The 8th Element of an Effective Compliance Program

Kevin C. Bennett, Partner, StoneTurn Group, LLP;
Kenneth L. Blickenstaff, Principal, BlickenWolf LLC 

Handout 1, Evaluation

302 Guidelines for Reporting Compliance Risks:
“Who Ya Gonna Call?”

Holly Robinson, Assistant Director, Medicare Compliance,
The Regence Group

Handout 1, Evaluation

Monday, February 22
Conference continued

3:00 – 4:00 pm
Breakout Sessions

401 Hot Topics from CMS

Scott Nelson, Senior Advisor in the Medicare Drug Benefit Group, CMS

Handout 1, Evaluation

402 Innovative Strategies to Measure, Report and
Improve the Efficiency of a Compliance Program

Robert Miromonti, Vice President, Ethics & Compliance,
Centene Corporation

Handout 1, Evaluation

• How Centene ensures regulatory and contract compliance and measures compliance risks
  
• How Centene uses compliance effectiveness measures to improve its culture of compliance
  
• How Centene integrates compliance into its overall
  Enterprise Risk Management Strategy

4:30 – 5:30 pm
Breakout Sessions

501 Medicare Audit Experiences

Kimberly Green, Compliance Officer, Blue Cross Blue Shield Northern Plains Alliances

Handout 1, Evaluation

502 Doing More with Less: Taking a Small Health
Plan’s Compliance Program to the Next Level

Lori Oleson, Compliance Director, UCare; Teresa Julkowski, Compliance Manager and Privacy Officer, UCare

Handout 1, Evaluation

• Small health plan discusses how its compliance program meets big scope
  
• These colleagues share tools that helped them accomplish more with less
  
• Best practices and lessons learned fostering an “audit
  readiness” culture across an organization

Tuesday, February 23

8:15 – 9:15 am

702 Office of Inspector General Work on Managed Care

Russell Hereford, Deputy Regional Inspector General for Evaluation and Inspections, US Department of Health and Human Services

Handout 1, Evaluation

9:30 – 10:30 am

General Session: ARRA and HITECH Panel

Kathryn Roe, Principal, The Health Law Consultancy; Jeannette Frey, Privacy Officer, Fallon Community Health Plan; Sharon Anolik, Blue Shield California

Handout 1, Evaluation

11:00 am – 12:00 pm
Breakout Sessions

601 CMS Compliance Plan Audit: How Ready
Are You? Get Ready, Get Set, Go For a Perfect
Score!

Anne Crawford, Medicare C & D Compliance Officer, Highmark Inc.

Handout 1, Evaluation

• Provide plan-tested approach for preparing for an
  compliance plan audit
  
• Successful strategies for securing supporting
  documentation
  
• Review validation approach for ensuring compliance with audit elements

602 A Tale of Training in the 21st Century

Kelly Wittmeyer, BS, CHC, CCS, CCS-P, Manager of Compliance Education and Reimbursement Data Quality, Sutter Health; Sally Gibbs, MA, RHIA, CCS, Sutter Health

Handout 1, Handout 2, Handout 3, Evaluation

• Learn from real world experiences to help energize your education and training program
  
• Take-ways include tips, tricks, pitfalls and our personal journal for you to learn from
  
• Gain knowledge of the latest e-learning technology

12:00 – 12:45 pm
Networking Lunch

1:00 – 2:00 pm
Breakout Sessions

701 Special Investigation Units

Dr. Donald Jones, VP-Audit and Regulatory Services, Practice Management Alternatives, LLC

Handout 1, Handout 2, Evaluation

• Compliance, Audit, and Investigations together to create a more effective plan
  
• Special investigations and the context of contact with
  providers
  
• SIU: Detection, Assessment and Investigative Strategy for resolution

702 Managed Care Roundtable

Evaluation

2:15 – 3:15 pm
Breakout Sessions

801 RAT-STATS and Sampling: Strategies for
Auditing and Government Enforcement Activity

Cornelia M. Dorfschmid, PhD, Executive Vice President, Strategic Management

Handout 1, Evaluation

• Sampling strategies for auditing, responding to government
  audits, preparing for disclosures
  
• Learn about two fundamental but different sampling
  concepts to get it right
  
• Understand and apply OIG Financial Error Rates, Error Rates, Probe Samples, and Discovery Samples

802 Medicare Advantage and Prescription
Drug Plans Assessing Your Plan’s Risks and
Prioritizing Compliance Resources

Elizabeth Lippincott, Elizabeth Barrett Lippincott, PLLC; Tom Bixby, Thomas D. Bixby Law Office

Handout 1, Evaluation

• Forecasting auditing trends: Tools you can use to predict what auditors will be looking for
  
• Targeting internal compliance audits to reduce your plan’s compliance risk
  
• Strategies for creation and deployment of monitoring tools