2019 Compliance Institute (CI)

  1. Mental Health Parity: Managing Compliance Across Commercial, Medicaid, and Duals Products

    2019 Compliance Institute (CI)  | Presenter(s): Helaine Fingold  | April 09, 2019 

    • Learn about Mental Health Parity requirements, including the most recent guidance from federal regulators, and how the rules differ for commercial, Medicaid and dual products

    • Gain insight into federal and state parity enforcement initiatives and oversight efforts

    • Discuss key issues in assessing parity, such as: Who is responsible for the parity assessment, how to address behavioral health carve outs and correctly identifying non-quantitative treatment limits

  2. Navigating Privacy Requirements When Integrating Mental Health, Substance Use Disorder and Primary Care Services

    2019 Compliance Institute (CI)  | Presenter(s): Elizabeth Winchell, Kristine Preston  | April 09, 2019 

    • Successfully providing co-located and integrated services depends on timely sharing of patient information—but there is no “one size fits all” approach

    • Understanding state and federal privacy laws is key when developing an integration program for mental health, substance use, and primary care services

    • The presenters will highlight key privacy issues and share practical lessons learned from their first-hand experience with integrated services

  3. Only Take a Calculated Risk: Empowering Leaders to Make Risk-Informed Decisions with a Modern Enterprise Risk Management Program

    2019 Compliance Institute (CI)  | Presenter(s): Stephen Mackey, Ashley Ferdinand  | April 09, 2019 

    • Discover the critical components for a successful Enterprise Risk Management program. These steps include crafting your charter, identifying ERM champions across your organization, and aligning with organizational strategy

    • Acquire new methods for uncovering, aggregating, and reporting on enterprise risks, your organizations's risk tolerance, and key risk indicators

    • Gain tools for evaluating the effectiveness of your Enterprise Risk Management program. Program will include lessons learned from building and implementing our ERM program. Learn from our mistakes so you don't have to make them!

  4. Patient Incentives or Inducements? Avoiding Pitfalls and Managing Risks

    2019 Compliance Institute (CI)  | Presenter(s): Catie Heindel, Rita Isnar  | April 09, 2019 

    • Overview of regulatory guidance particularly in the accountable care organization/provider and managed care setting

    • Discuss operational objectives and practical considerations in administering beneficiary incentives

    • Provide examples of how to design beneficiary incentives and avoid design flaws

  5. Physician Practice Enforcement Actions: Could You Be Next Year's News?

    2019 Compliance Institute (CI)  | Presenter(s): Sarah Couture, Glena Jarboe  | April 09, 2019 

    • Lessons learned from a twelve-month summary of published enforcement actions against providers and physician practices

    • Simplified approach to a risk assessment for your practice, large or small

    • Practical compliance plan development based on your risk assessment

  6. Physician Relationships in the Academic Medical Center Context: Anti-Kickback and Stark Law Issues

    2019 Compliance Institute (CI)  | Presenter(s): Amy Joseph, Christopher Collins  | April 09, 2019 

    • Discuss application of kickback and physician self-referral (Stark) laws to academic medical centers in the clinical care context and beyond, including with respect to engagement in medical education and research

    • Review recent developments in anti-kickback and Stark laws and apply evolving legal standards to various hypotheticals

    • Identify practical strategies to mitigate risk, including tips for preparing physician agreements, monitoring and auditing compliance with agreements and applicable policies, and addressing fair market value and commercial reasonableness

  7. Protecting the Bottom-line: Defending Claims with Policies & Procedures

    2019 Compliance Institute (CI)  | Presenter(s): Renee Blomme  | April 09, 2019 

    • Risk and claim management evolve through claims identification, investigation, discovery, mediation, and resolution. Learn how to achieve excellence by establishing standard policies, protocols, and procedures to guide your claims management process

    • Discover how modernizing your policy and procedure management platform enables the ability to verify staff have reviewed the most current policies, helps you easily and effectively defend claims and aids accreditation with easy access to approved policies

    • Learn how to eliminate liabilities by streamlining your healthcare claims management activities and reducing operational spending with digital policies and procedures easily accessible to all staff and dynamic workflows enable easy policy maintenance

  8. Real-World Strategies for Identifying, Measuring, and Reporting Risk

    2019 Compliance Institute (CI)  | Presenter(s): Betsy Wade  | April 09, 2019 

    • Learn how to refine your risk management process so it not only involves the right people, information, and implementation, but also conveys the importance and impact to your business decision makers

    • Discuss how to quantify business risk exposure and think like your CEO so you can get buy-in from your leadership team

    • Understand common barriers to success and how to overcome them

  9. Responding to Government Investigations and Compliance Matters

    2019 Compliance Institute (CI)  | Presenter(s): Lauren Marziani, Kirk OGrosky  | April 09, 2019 

    • Learn what investigative tools are used by DOJ and HHS-OIG to initiate different types of investigations

    • Understand the obligations of legal and compliance officers throughout an investigation

    • Best practices for addressing governmental investigations from hold notices document collection and production, internal investigations, and resolution

  10. The Spyware Nightmare

    2019 Compliance Institute (CI)  | Presenter(s): Regina Verde, Erin Trost  | April 09, 2019 

    • A spyware incident revealed itself when the FBI notified us of suspicious criminal activity. How would you respond if one of your providers was accessing your health system, unaware of the presence of malware?

    • We will inform attendees on the activation of data breach response procedures, the investigation and forensic review, analysis of patient data at risk, public breach notification and communications, and corrective actions taken

    • At end we will discuss steps a healthcare organization should take once a malware breach is suspected or has been determined, and how to protect your organization from these types of attacks. We will also reveal our most beneficial lessons learned

  11. The CI Is Over: Now What?

    2019 Compliance Institute (CI)  | Presenter(s): Frank Ruelas  | April 09, 2019 

    • Attendees will perform a self assessment using the 5WH1 model to identify next steps on actions to take once they arrive back at their own organizations

    • Compliance professionals will share with one another what they see as the most effective options to exercise within their organizations to show that their time and resources spent in attending the Compliance Institute was a sound investment

    • Strategies will be discussed and those interested will have a chance to participate in an ongoing support group to help them stick to their action plans that are based on what they learned while attending the Compliance Institute

  12. Telehealth or TeleHELL? Understanding the Complexities of Telehealth Beyond the Initial Set Up

    2019 Compliance Institute (CI)  | Presenter(s): Tonja Wise  | April 09, 2019 

    • We know what the basic rules are. Now what?? Understanding the complexities of consents, record sharing and more!

    • State Lines: Dare I cross them? Understanding more about how Telehealth is impacted by state borders

    • Is it okay if we... A comprehensive look at some of the strangest questions and answers for Telehealth operations!

  13. The #MeToo Movement: What Compliance Officers Should Know and How to Be Prepared

    2019 Compliance Institute (CI)  | Presenter(s): Kim Danehower  | April 09, 2019 

    • Overview of the #MeToo movement as it relates to the healthcare environment

    • Legal and compliance impact of allegations and investigations

    • How to educate and change an organization’s culture

  14. The Intersection of Clinical Quality and Regulatory Requirements in the Conditions of Participation

    2019 Compliance Institute (CI)  | Presenter(s): Jordan Muhlestein, Meghan Flaherty  | April 09, 2019 

    • How the backbone of Medicare hospital regulation creates internal friction when clinical aspects of COPs and the governance aspects of COPs collide and how to identify and manage the intersection

    • Managing the tension between systematized quality improvement and efficience with the single hospital-focused COPs

    • Lessons learned from an integrated health system's transition to centralized efficiency while ensuring compliance with local COP requirements

  15. M&A Transactions in Home Health and Hospice: Compliance and Due Diligence - How Do I Get This Right?

    2019 Compliance Institute (CI)  | Presenter(s): Alan Schabes  | April 09, 2019 

    • Compliance and due diligence challenges in home health and hospice transactions

    • Successful strategies for dealing with DOJ, OIG and state MFCU concerns

    • Maximizing the role of the compliance officer in home health and hospice M&A transactions

  16. The Compliance Professional's Approach to Auditing Rehabilitation Services

    2019 Compliance Institute (CI)  | Presenter(s): Yolunda Dockett, Holly Hester  | April 09, 2019 

    • Describe regulations guiding therapy practice, documentation, and billing

    • Review the required elements of therapy documentation

    • Identify key elements of an effective auditing and monitoring program for rehabilitation services

  17. Risk Management & Internal Investigations

    2019 Compliance Institute (CI)  | Presenter(s): Gerry Zack  | April 09, 2019 

    • Risk management: Leveraging effective internal coordination

    • Internal investigations: Customizing your investigations program to strategically remediate and mitigate risk

    • To privilege or not to privilege: Risk assessments, reviews, audits, and investigations

  18. Selling and Buying the Brooklyn Bridge: Lessons Learned from M&A Due Diligence

    2019 Compliance Institute (CI)  | Presenter(s): Regina Gurvich, Daniel Meier  | April 09, 2019 

    • Legal gymnastics of the deal, including structuring within Corporate Practice of Medicine, regulatory compliance, and due diligence across multi-specialty/multi-state acquisitions

    • Translating due diligence findings into an action plan for an effective, centralized compliance program and a scalable framework for future acquisitions

    • Lessons learned from successes and fiascos, actionable pointers, and a few tools to make it all work

  19. The State of Exclusions and OIG Enforcement Actions

    2019 Compliance Institute (CI)  | Presenter(s): Michael Rosen, David Blank, Geoffrey Hymans  | April 09, 2019 

    • We will review the latest statistics and breakdown of exclusions at the OIG and discuss trends and traps

    • Hear from a former Senior Counsel to HHS-OIG who advised OIG on exclusions and gain a better understanding OIG’s enforcement approach and how to avoid/mitigate enforcement

    • We will review relevant cases of enforcement and learn tips for effective exclusion monitoring

  20. Theranos Case Study: What Went Wrong?

    2019 Compliance Institute (CI)  | Presenter(s): Cindy Hart, Tomi Hagan  | April 09, 2019 

    • Join us for this interactive session to discuss how a young college dropout hoodwinked major venture capitalists

    • Discover the 8 signs of trouble that were overlooked and resulted in a $9 Billion fraud scheme

    • Explore these key questions: Would an effective compliance program cause the startup to fail or succeed? What is the role of the compliance professional when faced with signs of fraud? Is an industry that affects people’s lives held to a higher standard?

  21. Statistical Sampling in Healthcare Audits and Investigations

    2019 Compliance Institute (CI)  | Presenter(s): Michael Holper, Stefan Boedeker  | April 09, 2019 

    • Discuss increasing use of statistical sampling and extrapolation of overpayment liabilities by federal and state audit contractors, regulators, and commercial payers

    • Discuss the fundamentals of proper statistical sampling, how to draw reliable conclusions from a sample to the underlying universe of claims, and statistical sampling of healthcare claims by regulators and third-party auditors

    • Discuss experiences in defending healthcare providers against the use of flawed statistical sampling and extrapolation models, including experience in pursuing available administrative appeals

  22. The Fifth Element of An Effective Compliance Program: Monitoring, Auditing, and Internal Reporting Systems

    2019 Compliance Institute (CI)  | Presenter(s): Vicki Dwyer, Nancy Kennedy  | April 09, 2019 

    • Strategies and ideas on how to ensure auditing and monitoring are fully integrated into your Compliance Program

    • Guidance and strategies on how to tailor the 5th Element of auditing and monitoring for your specific organization. Once Size does not fit all!

    • Discussion on how and when to move from the 5th Element (Auditing & Monitoring) to the 7th Element of Investigations and Remedial Measures when significant concerns are identified

  23. Tales from the Trenches: An Inside Look at How Different Organizations Account for and Meet the Challenges of MACRA

    2019 Compliance Institute (CI)  | Presenter(s): Jackie Robertson-Gutshall, Shelley Timko  | April 09, 2019 

    • Learn how you can: implement a new EMR system AND be a new or repeat MACRA participant, identify workflow-friendly measures, regardless of specialty; and apply/receive an exception approval, to achieve maximum scores, using ONLY minimal resources

    • Navigate the minefields of MACRA by educating/receiving buy-in from all roles at all levels; from C-Suite to staff that is ultimately responsible for documenting the details; and receive proven examples on how to overcome technical/performance barriers

    • Understand how to create processes and templates to give real-time provider feedback; and identify low-tech methods to capture missing data; ALL to propel you from “this sounds great in theory” to potentially earning maximum positive payment adjustment

  24. Data, Monitoring and the Culture of Privacy

    2019 Compliance Institute (CI)  | Presenter(s): Lauren Steinfeld, Andrea Thomas-Lloyd  | April 09, 2019 

    • Learn how a leading health system adopted a strong privacy monitoring approach by implementing a clinically-aware and AI‑enabled platform that brings together data from many disparate sources to identify possible threats to patient privacy

    • Understand how this transition improved the organization’s ability to strengthen the culture of privacy sensitivity

    • Learn about the key metrics the organization tracks to determine the effectiveness of its privacy operation and how it uses this data to improve the strength of its program

  25. Five Strategies to Create Compliance Allies

    2019 Compliance Institute (CI)  | Presenter(s): Cindy Matson  | April 09, 2019 

    • Identify five strategies for compliance and ethics professionals to create allies within their organization

    • Discuss easy to implement tactics that can be used to put the strategies into practice and why each tactic can make a difference

    • Recognize that having allies is a win-win for both compliance and operations and learn how it positively influences the effectiveness of a compliance program