Sunday, February 6
Pre-Conference
8:00 – 10:00 am
P1 Effective Managed Care Organization Compliance Programs
Jenny O'Brien, JD, CHC, Medicare Compliance Officer,
UnitedHealth Group/PSMG
Presentation, Handout, Evaluation
10:15 am – 12:15 pm
P2 Being a Compliance "Operative": Working Effectively Across Health Plan Functions
D. Derek Jones, CHC, The Healthcare Investigations Group,
Practice Management Alternatives, LLC
Holly Robinson, Assistant Director of Medicare Compliance, The Regence Group
Presentation, Evaluation
- The Org Chart notwithstanding, how can Compliance
interdependence work among Legal, Risk, Regulatory,
Special Investigations, Claims, Medical and Provider
Relations (among the many) to produce the result you need?
- Decide where compliance has the most beneficial impact from the beginning to the end of what you do as a health plan. It's not always at the same level in each functional department.
- Increasingly, states are mandating investigative
departments and Fraud and Abuse Plans. How can we best meet these mandates?
1:15 – 3:15 pm
P3 New State Mandates – Now What?
Jim Bixler, Vice President, Ethics & Compliance, WellPoint, Inc.
Presentation, Evaluation
3:30 – 5:30 pm
P4 Medicare
Anne Hance, Partner, McDermott Will & Emery LLP
Robert Slavkin, Of Counsel, Akerman Senterfitt
Presentation, Evaluation
Monday, February 7
Conference
8:15 – 9:00 am
8:15 – 9:00 am General Session
Health Care Reform Panel: How My Plan Is Dealing with HC Reform
Patrick Haley, Government Programs Compliance
Officer, Blue Cross Blue Shield of Michigan
Michael Patterson, Vice President, Blue Cross and
Blue Shield of Alabama
Presentation 1, Presentation 2, Evaluation
9:00 – 10:00 am General Session
CMS Hot Topics
Helaine Fingold, Director, Division of Surveillance, Compliance and Marketing
Brenda Tranchida, Director, Program Compliance and
Oversight Group Director
Judy Geisler, Director, Division of Formulary & Benefit
Operations, Medicare Drug Benefit and C & D Data Group
Cynthia Moreno, Division Director of Medicare
Modernization Act Integrity, Center for Program Integrity
Presentation 1, Presentation 2, Presentation 3,
Presentation 4, Evaluation
10:15 – 11:15 am Breakout Sessions
101 Who's Knockin' at Your Door? Identifying and Tackling Your Data Security Risks
Teresa Julkowski, Privacy and Data Security Officer, UCare
Lori Oleson, Compliance Director, UCare
Presentation, Evaluation
- Year of Data Security raises employee awareness
and achieves specific security measures
- Data Security Risk Management Committee reviews
and prioritizes security initiatives
- Internal and external resources for balanced effective
risk assessment
102 Management Behavior and the Culture of Compliance
Randy Romrell, Director, Ethics & Compliance, The Regence Group
Presentation, Evaluation
11:15 am – 12:00 pm
Lunch
12:15 – 1:15 pm Breakout Sessions
201 HIPAA Breach Notification: Case Studies on What to Do and When To Report
Elizabeth Callahan-Morris, Attorney and Counselor,
Hall Render
Caron R. Cullen, CHC, Vice President, Compliance &
Regulatory Affairs, Affinity Health Plan
Presentation, Evaluation
- Discuss the CBS new story about ePHI stored on a
photocopier's hard drive and other real life data breach
situations.
- How to deal with the media and manage public relations
when there is a data breach.
- Walk through a breach analysis, risk assessment, and
notification process.
202 State Division of Insurance Rate Disapprovals: Preparing for the Onslaught
Jesse M. Caplan, Partner, EPSTEINBECKERGREEN
Presentation, Handout 1, Handout 2, Evaluation
- State DOIs are under pressure to hold down health
insurance premiums by dispproving rate increases
- State authority, while broad, does have its limits, as
demonstrated in Massachusetts
- The rate disapproval landscape, and strategies for avoiding, and prevailing in rate proceedings
1:45 – 2:45 pm Breakout Sessions
301 Regulatory Compliance Oversight
Anne Crawford, Medicare C & D Compliance Officer,
Highmark Inc.
Cinday Todd,Office of Corporate Ethics & Compliance, Privacy Office/Compliance360 System Administrator, Excellus BlueCross BlueShield
Presentation 1, Presentation 2, Evaluation
- Different approaches for internally distributing regulatory notices
- Learn efficient documentation strategies (milestone
tracking)
- Techniques to validate that the successful implementation
- Develop a monitoring and auditing program (closed loop process)
- Survival techniques when a regulator is auditing/validating your regulatory notification process
302 Executive Dashboards: Using Data to Make Better Decisions
Matthew Cruse, CHC, Compliance Officer, Medica
HealthCare Plans, Inc.
Presentation, Evaluation
- If CMS is monitoring your organization on a daily basis,
shouldn't you?
- Early identification of potential compliance risks and areas
of improvement
- Effectively communicate compliance findings and results to senior management and the board
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Monday, February 7
Conference continued
3:00 – 4:00 pm Breakout Sessions
401 CMS Mandatory Compliance Plans
Brenda Tranchida, Director, Program Compliance and Oversight Group Director
Vernisha Robinson, Senior Technical Advisor, Program Compliance and Oversight Group
Angela Brice-Smith, Director, Medicaid Integrity Group, Center for Program Integrity
Cynthia Moreno, Division Director of MMA Integrity, Center for Program Integrity
Presentation 1, Presentation 2, Evaluation
- Recent Updates and Developments (Medicare/Medicaid)
- Medicare Drug and Managed Care Health Plan Sponsors
- Effectiveness Evaluation/Audits
- Self Assessment Tools
- Importance Of Governing Body and Senior Management
Involvement And Oversight
- Lessons for Other Regulated Entities
402 Compliance Risk Management Strategy: Integrated Approach
Kara Curtis, Director, Strategic Business Initiatives &
Compliance Commonwealth Care Alliance
Presentation, Evaluation
- Compliance Risk Management: Key Components
- Building Business Case for Internal Buy-In
- Roles/Responsibilities: Business Owner vs. Compliance
- Practical Tools & Best Practices
501 Fraud and Abuse
Sharon LG Donnelly, AHFI, CFE, Director, SIU Business
Assurance Division, Blue Cross Blue Shield of Florida
Presentation, Evaluation
502 How to Prepare for, Survive, and Learn from
CMS Compliance Program Audits
Elizabeth Lippincott, Lippincott Law Firm PLLC
Presentation, Evaluation
- Requirements and best practices for compliance programs
under the April 2010 updates to CMS regulations for
Medicare Advantage and Part D plans
- How to prepare your company for a CMS Compliance
Program Audit
- Recommendations for internal management of a CMS
Compliance Program Audit
- Ways to use the audit preparation process, as well as the
exercise of responding to CMS' findings, to strengthen your
compliance program's effectiveness
Tuesday, February 8
8:15 – 9:15 am General Session
OIG Hot Topics
Russell Hereford, Deputy Regional Inspector General for
Evaluation and Inspections, US Department of Health and
Human Services
Presentation, Evaluation
9:15 – 10:30 am General Session
Case Studies: Breach Notification Compliance— The Feds Are Watching
Erika Bol, CHC, CPHRM , Privacy Officer, Department of
Health Care Policy and Financing
Presentation, Evaluation
11:00 am – 12:00 pm Breakout Sessions
601 A Day in the Life of a Privacy Officer
Jeannette Frey, Privacy Officer, Fallon Community Health Olan
Presentation, Evaluation
602 New Enforcement Era for MA and Part D Plans: What PLANs Need to Do Now to Be Ready
Marci Handler, EPSTEINBECKERGREEN
Presentation, Evaluation
- Lessons learned from recent federal enforcement actions involving managed care companies
- Program Integrity provisions enacted in Health Reform
that affect managed care
- How to modify your compliance plan to protect yourself
12:00 – 12:45 pm Lunch
1:00 – 2:00 pm Breakout Sessions
701 Verifying Compliance Program Effectiveness in Managed Care
Cornelia M. Dorfschmid, Executive Vice President,
Strategic Management
Presentation, Evaluation
- Define and understand difference between Systems &
Transaction Reviews, Evaluations in compliance
- Systems & Transactions Reviews, Evaluations can be used to evidence CP effectiveness by any entity
- Maximize CP auditing & monitoring in the managed care environment
702 Records and Information Management
Program—"More than Document Retention"
Susan B Whitmire, CRM, FAI, Manager, Enterprise Records
& Information Management, Corporate Compliance, BlueCross BlueShield of TN
Judith Nelson, Vice President, Chief Compliance Officer
BlueCross BlueShield of TN
Presentation, Evaluation
- Examine organizational business issues and approaches to assessing risks that gain momentum for enterprise content management
- Apply methods for planning, strategizing, and managing the overall project and program to gain user awareness, adoption, and acceptance of your policies, programs, and tools
- Identify your internal risks to aid the development of the strategy for your organization
2:15 – 3:15 pm Breakout Sessions
801 Q&A Panel
Lori Oleson, Compliance Director, UCare
No Presentation Available, Evaluation |
