2019 Healthcare Enforcement Compliance Conference

  1. General Session: 2019 Update from CMS (2019 Healthcare Enforcement Compliance)

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Kim Brandt  | November 04, 2019 

    • Update on the agency’s ongoing burden reduction and regulatory reform efforts

    • Recent steps to advance interoperability and data sharing

    • CMS efforts to combat the opioid epidemic, including SUPPORT Act initiatives

    • Updates on CMS program integrity focus areas and regulatory changes

  2. General Session: Government Enforcement Panel (2019 Healthcare Enforcement Compliance)

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Kirk Ogrosky, Alec Alexander, Gustav W. Eyler, David Tanay  | November 04, 2019 

    • Discussion of DOJ Criminal and Civil Enforcement Priorities

    • Discussion of OIG and CMS Enforcement Initiatives

    • Discussion of Medicaid Fraud Enforcement Priorities

  3. Privacy Breach Response

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Blaine A. Kerr, Gregory V. Kerr  | November 04, 2019 

    • A discussion of the importance of being proactive about data security and how information security is a dynamic process that must assess risks to e-PHI on an ongoing basis

    • Strategic insights to navigate interaction with the media such that protected health information is not disclosed in an egregious way

    • Methods to assess when a Business Associate Agreement is necessary and the obligations of the business associate throughout the life cycle of PHI

  4. Privacy and Compliance, HIPAA, State Law, and GDPR

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Iliana Peters, Uday Ali A. Pabrai  | November 04, 2019 

    • Examine the state of federal and state privacy and security priorities that will impact regulated entities in 2020, particularly regarding compliance and enforcement

    • Review key HIPAA and GDPR challenges that continue to impact organizations

    • Discuss the leveraging cybersecurity frameworks such as NIST CsF and HITRUST enhance entities’ compliance programs

  5. Risk Management for Compliance Officers

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Steven W. Ortquist, Scott Grubman  | November 04, 2019 

    • How and when are compliance officers at risk? What guidance, enforcement actions and war stories tell us

    • Managing and mitigating risks: How can you protect yourself?

    • What to do if you run into a challenge

  6. HHS Health Industry Cyber Security Practices: Managing Threats and Protecting Patients

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Karen Greenhaigh, Erik Decker  | November 04, 2019 

    • HHS convened over 150 cyber security officers, privacy experts, medical professionals, and healthcare industry leaders to strengthen the US Healthcare and Public Health cyber security posture. In January of 2019 this task group released voluntary guidance

    • In easy to understand terms, learn the 5 cyber security threat vectors that are most impactful. Understand the 10 Best Practices, supported by HHS/OCR, for suggested mitigation strategies across small, medium, and large organizations

    • Ensure your organization is focusing on the highest risk threats with appropriate control techniques, policies, and procedures. Templates and toolkits will quickly integrate this knowledge into effective compliance and risk management programs

  7. Lessons from Stark Investigations

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): David M. Glaser, Matthew Krueger  | November 04, 2019 

    • A U.S. Attorney and defense lawyer discuss how cooperation between the government and defendants can lower the cost of an investigation

    • Analysis of Stark’s complexities, including how regulatory definitions can undermine arguments for both parties

    • Exploration of the limitations in salary survey data and why it can be difficult to evaluate fair market value compensation

  8. Nurse Practitioners and Physician Assistants: Emerging Compliance Issues for Hospitals

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Carolyn Buppert, Elizabeth Skinner  | November 04, 2019 

    • Compliance professionals must understand billing requirements when the rendering clinician is a nurse practitioner or physician assistant and when clinical work is shared with physicians

    • Hospitals should not allow their employed nurse practitioners and physician assistants to be utilized by self-employed physicians. It’s a Stark Law problem

    • New state and CDC guidelines on prescribing opioids have opened up a new line of fraud cases involving nurse practitioners and physician assistants. Compliance professionals should have general knowledge of state and national guidelines for prescribing

  9. What Makes a Compliance Program "Effective"?

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Thomas Beimers, Heather Noughton Bokor, Felicia Heimer  | November 04, 2019 

    • Discuss new and historical published guidance on compliance programs, measuring effectiveness, and program evaluation

    • Discuss benchmarking and the use of industry enforcement activity and Corporate Integrity Agreement requirements in your program

    • Discuss tips for achieving effectiveness in your organization and the view from multiple vantage points

  10. Cyber Security and Health Care Privacy

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Roy Wyman, David Kessler, Marti Arvin  | November 03, 2019 

    • Assessing current cyber security and privacy legal landscape and enforcement actions

    • Emerging technologies: Cyber security and privacy risks for healthcare-related entities

    • Addressing risks from supply chain and third-party vendors to help reduce enforcement risks

  11. Anti-Kickback Developments

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Tony Maida, Sally Molloy, Jillian Sparks  | November 03, 2019 

    • Discussion of the recent OIG notice of proposed rule-making on value-based payments and regulatory burden reduction

    • Overview of recent anti-kickback enforcement actions and settlements

    • Review of the new all-payor kickback statute, Eliminating Kickbacks in Recovery Act of 2018 (EKRA)

    • Insights on how these developments impact your compliance program and strategies to mitigate risk

  12. Anatomy of a False Claims Act Case

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Katherine Lauer, Maddie Bainer  | November 03, 2019 

    • The Investigation Phase: subpoenas/ CIDs, data analysis, witness interviews and more

    • The Negotiation Phase: Initiation, ADR, scope of release, monetary and other issues

    • The Resolution Phase: Settlement agreements, individual liability, CIAs/ OIG and relator issues

  13. Compliance, Repayment and Self-Disclosure

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Brian Bewley, Heather Noughton Bokor, David Fuchs  | November 03, 2019 

    • Discuss applicable rules and provider obligations to return a known overpayment

    • Discuss best practices in identifying, quantifying, and remedying an overpayment

    • Discuss options and considerations for remedying an overpayment for simple repayments and voluntary disclosures

  14. Corporate Integrity Agreements: The Role of an Independent Review Organization (IRO)

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Steven W. Ortquist, Glen Moyers, Amanda Copsey  | November 03, 2019 

    • Why do CIAs include an IRO? Frequently utilized review requirements

    • How have the roles and obligations of IRO been modified in recent years? What is behind the modifications?

    • Working with your IRO: Keys to a Successful IRO engagement

  15. Enforcement and Compliance for General Counsel and Compliance Officers

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): John Kelly, Lisa Adkins, Shannon Sumner  | November 03, 2019 

    • Enforcement agencies, government regulators, and whistleblowers remain focused on pursuing healthcare fraud and abuse matters, placing compliance programs and legal counsel as the first lines of defense

    • With so much at risk, our panelists will provide guidance and advice about what is keeping them up at night from the different perspectives of in-house counsel, compliance officer, and outside counsel

    • The panelists will provide advice on best practices to minimize the identified risks and enhance both legal and compliance functions

  16. Federal Administrative Sanctions: Exclusions, Civil Money Penalties, and Case Update

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Michael Torrisi, Kristin C. Carter  | November 03, 2019 

    • Overview of HHS-OIG and CMS administrative enforcement tools and sanctions, including civil monetary penalties, exclusions, revocations, and suspensions

    • Trends, priorities, and updates in HHS-OIG enforcement and CMS program integrity actions

    • A review of recent federal administrative healthcare enforcement actions

  17. Litigating a False Claims Act Case

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): John T. Boese, Robert Vogel, Latour "LT" Lafferty, Patrick Klein  | November 03, 2019 

    • Common motions in FCA litigation

    • Proving/disproving falsity, knowledge and damages after Escobar

    • Discovery and trial issues in intervened vs. nonintervened cases

    • Escobar-related discovery from the government regarding claims payment

  18. Managed Care Enforcement and Compliance

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Kay Mesia, Rose Dunn  | November 03, 2019 

    • FDR enforcement in a Medicare Advantage Plan: Compliance process and oversight

    • RADV expectations of Medicare Advantage for claims data accuracy

    • Deficiency remediation

  19. Navigating Enforcement Actions, Investigations, and Settlements

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Ana-Cristina Navarro, Anne S. Daly, Christina M. Villa  | November 03, 2019 

    • This session will provide an overview, through a case study, of how an organization can have an adverse event lead them down the path of government surveys and formal enforcement actions on multiple levels, including a 195 item Systems Improvement Agreement

    • Illustrate how a compliance team can, and should, assist in facilitating the planning and actions needed to not only overhaul a Health Care Organization’s (HCO) policies and training, but also to support the change in culture

    • Provide tools and methods for supporting the organization wide efforts, as well as lessons learned and mechanisms to help prevent your organization from having to navigate the choppy waters of a formal enforcement action

  20. Negotiating False Claims Act Settlements and Mediation

    2019 Healthcare Enforcement Compliance Conference  | Presenter(s): Laura Laemmie-Weidenfeld, Jack Wenik, Janice M. Symchych, Sean O'Connell  | November 03, 2019 

    • Latest developments in False Claims Act settlements, including new DOJ policies and the effect of Universal Health Services v. United States ex rel. Escobar

    • Negotiating False Claims Act settlements including corporate and individual settlements

    • Drafting False Claims Act settlement agreements from the defense and government perspectives