2020 Healthcare Enforcement Compliance Conference

  1. CIAs and IROs: What Are They and Why Do They Matter?

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Bert F. Lacativo , Steve Ortquist, Laura Ellis  | November 18, 2020 

    • An introduction to Corporate Integrity Agreements (CIAs) and the requirement for the settling organization to engage an Independent Review Organization (IRO)

    • Receive an overview of who can become an IRO along with a discussion of the IRO function

    • Learn how an IRO interfaces with the organization, its expectations and reporting responsibilities

  2. Data Analytics and AI to Detect and Defend Fraud

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Samantha B. Badlam , Emily Treanor  | November 18, 2020 

    • Kickbacks and fraud can hide in dark corners of your organization. Data analytics and AI can provide powerful tools to prevent and detect such behaviors. Join an interactive panel using sample data and visualizations

    • Learn from a former in-house compliance counsel and current outside counsel with enforcement expertise about how data analytics and AI can transform the risk management efforts of healthcare organizations of any size

    • Learn how shifting expectations of government agencies mean that not using data analytics and AI to prevent and detect kickback and fraud risks is no longer a viable option for healthcare organizations

  3. Compliance Officers, General Counsel and Enforcement

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Mara Senn, Jeff Hessekiel , Kirk Ogrosky  | November 18, 2020 

    • Discover DOJ’s current 2020 enforcement priorities

    • Understand how conflicts of interest impact investigations

    • Learn the GC’s and CCO’s roles in conducting internal investigations

    • Hear when companies and providers need to retain outside counsel

    • Apply best practices to issue spot in today’s enforcement environment

  4. Compliance, Internal Investigations and Self Disclosure: Building the Team, Process, and Resolution

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Gabriel Imperato , Nancy Hayt  | November 18, 2020 

    • Identifying potential non-compliance through an effective compliance program

    • Organizational governance and internal investigations; authority and practical considerations

    • Methodology for internal investigations; establishment, personnel and resources, probable cause and preponderance of evidence, privilege, and findings of fact

    • Practical tips; investigation workplan, conducting interviews, collecting documents and e-data, establishing facts and final report Resolution; remedial action and self-disclosure and managing the risk

    • Compliance professionals and best practices

  5. Electronic Health Records Fraud Enforcement: What, Why, and Thoughts for Compliance Professionals

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Ryan O'Quinn , Joshua A. Boxer, Karen Stewart  | November 18, 2020 

    • Overview of government enforcement actions related to EHR providers. A new era in enforcement - software meets false claims

    • Accreditation and ongoing compliance obligations related to EHR providers and those providers who use them for incentive reporting

    • Proactive measure for compliance professionals to prevent and mitigate exposure

  6. Handling a Criminal Healthcare Fraud Case

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Ralph Caccia , Lisa Miller  | November 18, 2020 

    • Understanding Current DOJ Criminal Enforcement Priorities

    • What you as a Compliance Officer can do to identity red flags

    • Provide guidance on why some fraud cases are handled civilly while others are prosecuted criminally

    • Provide an overview of the common health care fraud scheme types

    • What you can do as a Compliance Officer to best position your company in the event of a criminal investigation

    • Identify common errors made in the course of criminal investigations

    • Understanding what the government expects to facilitate restitution in the event of fraud

  7. Root Cause Analysis Workshop (2020 Healthcare Enforcement Compliance Conference)

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Dwight Claustre, Rosalind Cordini  | November 18, 2020 

    • Participants will review and understand the Department of Justice’s 2020 guidance pertaining to the performance of root cause analyses

    • Participants will understand the root cause analysis structure and purpose

    • Participants will perform a root cause analysis pertaining to a [mock] serious compliance issue to learn skills for the performance of a root cause analysis in their institutions/organizations

  8. Negotiating and Mediating False Claims Act Cases

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Sean B. O'Connell , Janice Symchych , Marc S. Raspanti, David Cohen  | November 18, 2020 

    • The increased difficulties in negotiating and settling False Claims Act cases

    • Understanding the roles of the different stakeholders in False Claims Act cases and what they’re entitled to

    • Understanding the risks of going to trial and why it may be the best option

  9. Strategies and Best Practices for Responding to Enforcement Activities

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Gabriel Imperato , David Glaser  | November 18, 2020 

    • Responding to criminal, civil or administrative enforcement actions

    • Best practices for interaction with government attorneys, agents and auditors

    • Preparing current and former employees for government contacts

  10. Is your Conflicts of Interest Program Effective?

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Julie Hamilton , Debra Berns, Colleen Curran  | November 18, 2020 

    • Highlights of regulatory and enforcement activity related to conflicts of interest (COI)

    • Components of an effective COI program

    • Lessons learned and tactical steps for assessment and enhancement of COI programs

  11. Litigating a False Claims Act Case (2020 Healthcare Enforcement Compliance Conference)

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Scott Grubman, Linda McMahon  | November 18, 2020 

    • Define and discuss key provisions of the False Claims Act that regularly get litigated

    • Identify emerging issues that often arise during FCA litigation

    • Learn strategies for maximizing discovery in FCA cases

  12. Medicaid Fraud Enforcement Update

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Jack Wenik , Josh Lichtblau  | November 18, 2020 

    • Recent developments in Medicaid fraud/abuse enforcement at the state level, including managed care organizations

    • Focus on home health, adult day care and other providers receiving extra scrutiny

    • Government and defense perspectives on responding to Medicaid fraud and abuse investigations

  13. Medical Necessity and Civil and Criminal Liability

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Judy Ringholz, Jeffrey Dickstein , Alison Rousseau , Brian Bewley  | November 18, 2020 

    • Medical necessity cases are very much alive in the FCA world, though the environment is ever-changing. This panel, consisting of an attorney in DOJ’s Civil Division, a health system chief compliance officer, defense counsel and relator’s counsel will examine the evolving landscape

    • We will consider the primary legal issues involved in medical necessity cases, recent relevant court rulings, as well as the regulations typically in play in common questions of medical necessity

    • We will discuss when fraudulent conduct becomes criminal conduct in cases alleging medically unnecessary testing and/or procedures

    • Do robust compliance measures prevent medical necessity cases? Do aggressive defense tactics head them off? We will examine the effect of compliance and defense strategy on DOJ investigations of allegations of lack of medical necessity

  14. Understanding the Components of a Comprehensive Compliance Risk Assessment Process

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Anne Daly , Thomas Herrmann  | November 18, 2020 

    • Review the importance of risk assessment in health care compliance, including an overview of historical and recently published health care regulator guidance and enforcement (DOJ, OIG, OCR, etc.)

    • Outline and discuss the core components for a credible compliance risk assessment process

    • Elaborate on processes, tips, and best practices for implementing and supporting compliance risk identification and mitigation

  15. Anatomy of a False Claims Act Case (2020 Healthcare Enforcement Compliance Conference)

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Sean B. O'Connell , Lisa Re, Arthur Di Dio , Michael Morse  | November 18, 2020 

    • 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

  16. Big Data: How Can It Be Shared and What Are the Considerations Regarding Enforcement?

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Marti Arvin , Blaine Kerr  | November 17, 2020 

    • Brief primer on the way in which individually identifiable information can be shared with regulatory parameters, both federal and state

    • Discussion of considerations when evaluating the sharing of big data sets with third parties for healthcare operations and/or research

    • Overview of the enforcement trends: Where it has been, where it is going, consumer privacy concerns, class actions and more

  17. CMS Oversight and Enforcement of Safety and Quality Standards

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Peter Urbanowicz, David Wright  | November 17, 2020 

    • Learn how CMS is enhancing its oversight activities, including oversight of State Survey Agencies and accrediting organizations, in order to fulfill its critical obligation to develop and enforce essential standards for safety and quality

    • Measures providers can implement to recognize and address quality and safety deficiencies to avoid increased survey activity and enforcement actions

    • If a CMS survey is inevitable, learn how to prepare for and what to expect during the visit and how to best respond to CMS requests and findings

  18. Civil and Criminal Telehealth Enforcement Matters; DME, Pharmaceutical and Other Covered Items and Services

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Jason Mehta, Colin Huntley  | November 17, 2020 

    • Understand the risks and opportunities associated with telemedicine

    • Understand the government’s increasing focus of telemedicine-related cases and what is to come

    • Understand the contours of telemedicine’s rules and how Medicare’s reimbursement paradigms have changed with COVID

  19. Enforcement and Compliance Risks Associated with the Opioid Crisis: Who's to Blame Will Cast a Wide Net

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Natalie A. Waites, Robert G. Trusiak  | November 17, 2020 

    • How do compliance professionals manage, and not overmanage, mismanage or not manage the crisis

    • Government and responses to the opioid crisis

    • Next steps for tomorrow morning

  20. Get 'Em Where it Hurts: Using Compensation to Influence Compliance

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Steve Schoenly , Alyssa Lawrence  | November 17, 2020 

    • Carrot or the stick: Determining reward or consequence shapes human behavior

    • Governance impacts ability: How compliance can work with management to achieve goals

    • Money talks: If you can equate compliance with compensation, you’re in the gold

  21. General Session - DOJ's Consumer Protection Branch: Safeguarding Americans from Dangerous Drugs and Devices

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Gustav Eyler  | November 17, 2020 

    • Learn about the work and enforcement priorities of the U.S. Department of Justice’s Consumer Protection Branch

    • Understand enforcement aims in the COVID-19 regulatory environment

    • Identify risks and compliance considerations associated with clinical trial fraud, reporting requirements, and data privacy

  22. General Session: CMS Update (2020 Healthcare Enforcement Compliance Conference)

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Kim Brandt  | November 17, 2020 

    • Overview of CMS COVID-19 response and flexibilities: Waivers and interim final rules

    • Update on CMS strategic initiatives, including Patients Over Paperwork and Interoperability

    • Review of proposed updates to the Physician Self-Referral or “Stark” Law

    • Learn about CMS program integrity initiatives and reforms

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

  23. Hot OIG Target Area: Device Reporting & Related Outlier

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Michael Calahan  | November 17, 2020 

    • Review the newest OIG-favored target area for hospital audits and learn the 2020 rules & regulations as well as Medicare Program changes for medical device credit reporting

    • Hospital Inpatient, Hospital Outpatient and ASC: Do you know how to identify which devices get reported when a credit is received? Do you know how to correctly report the credits in each of these settings?

    • Clouding the picture for accurate reporting: Newly invigorated OIG audits with a specific target of APC outlier payments related to medical device credits. Do you know if you are receiving additional outlier payments?

  24. Laboratory Enforcement and Compliance

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Brandy Frey, Karen Glassman, Ryan Stumphauzer  | November 17, 2020 

    • Recent case studies, with a discussion of what those cases tell us about risks related to medical necessity and arrangements

    • Practical solutions and best practices for mitigating risk

    • Updates on the Eliminating Kickbacks in Recovery Act

  25. Negotiating CIAs: What's New, What's Different, What Do You Need to Know?

    2020 Healthcare Enforcement Compliance Conference  | Presenter(s): Mary Findley, Felicia Heimer  | November 17, 2020 

    • New provisions and requirements in the CIA

    • Provisions OIG is willing to negotiate

    • Top 10 FAQs