2023 Virtual Managed Care Compliance Conference

1. GENERAL SESSION: As Managed Care Grows, OIG Oversight Continues to Grow

   2023 Virtual Managed Care Compliance Conference  | January 31, 2023 

   • Recent OIG work in managed care

   • Using data analytics to identify risk areas

   • Upcoming OIG work and oversight trends

2. OMG It's the OIG

   2023 Virtual Managed Care Compliance Conference  | January 31, 2023 

   • Key factors driving OIG Special Agent Investigations:

   • They are not what you have heard/read

   • List of complex issues uncovered on investigation and how to mitigate risks to avoid going to jail

   • List key statements, data trends and referral patterns to indicate fraudulent activity

3. Not Another FYRE Festival - Don't get stuck on an Island: A Primer on Understanding Compliance with Medicare Marketing Guidelines

   2023 Virtual Managed Care Compliance Conference  | January 31, 2023 

   • This presentation will cover a basic overview of CMS Medicare Marketing Guidelines

   • Oversight of sales agents/brokers (scope of appointments, agent/broker compensation and examples of dos and don'ts)

   • Communication and marketing requirements (marketing at sales events, nominal gifts, promotional activities)

4. Best Practices for Oversight and Monitoring a Medicare Part D Program to Ensure Quality and Compliance

   2023 Virtual Managed Care Compliance Conference  | January 31, 2023 

   • Review Medicare Part D requirements for tracking with a successful program

   • Describe oversight and monitoring activities within the Part D space including internal processes and delegation activities

   • Describe how these processes ensure compliance with Medicare Part D requirements including corrective action plan assignment and resolution

5. Managing the New Wave of Cybersecurity Compliance Challenges

   2023 Virtual Managed Care Compliance Conference  | January 31, 2023 

   • Identify and triage the top threats to data security, including new pandemic-related threats

   • Learn effective auditing and monitoring strategies to mitigate threats to data and privacy

   • Adopt strategy for data risks associated with telehealth, and mobile and at-home workforces

6. Best Practices in Identifying and Preventing Medicare Risks

   2023 Virtual Managed Care Compliance Conference  | January 31, 2023 

   • Reviewing regulatory guidance to keep abreast of what's changing and what's new

   • Utilizing risk assessments that are dynamic to drive robust monitoring and auditing

   • Creating good partnerships and communication pathways with operational units and vendors

7. Failing to Prepare = Preparing to Fail: A Three-Phase Approach to Best Position Your Organization for a Successful CMS Program Audit

   2023 Virtual Managed Care Compliance Conference  | January 31, 2023 

   • Phase 1: Diagnose data-confirm your ability to collect data universes in the required format within strict audit timeframes and analyze data for quality assurance

   • Phase 2: Scour samples-review your audit universes through the eyes of CMS

   • Phase 3: Remediate risks-fix identified non-compliant conditions and prevent recurrence, prepare your staff to explain the issues during audit webinars, and disclose to CMS

8. A Whole New World: Designing and Implementing a New Compliance Program

   2023 Virtual Managed Care Compliance Conference  | January 31, 2023 

   • Culture shift: How to establish a tone at the top and a true culture of compliance

   • Where to start: Designing the roadmap for successful implementation of processes and systems

   • Best practices: Sharing wins and lessons learned from experience in implementing new programs

9. Managed Care Conference - Establishing an Enterprise ERM/GRC Strategy with Compliance in Mind

   2023 Virtual Managed Care Compliance Conference  | January 31, 2023 

   • Understand the concepts and alignment of enterprise risk management and governance, risk, and compliance

   • Learn how to facilitate engagement across governance groups

   • Identify the key benefits of an aligned ERM/GRC strategy

10. V8 - Establishing an Enterprise ERM/GRC Strategy with Compliance in Mind

    2023 Virtual Managed Care Compliance Conference  | January 31, 2023 

    • Understand the concepts and alignment of enterprise risk management and governance, risk, and compliance

    • Learn how to facilitate engagement across governance groups

    • Identify the key benefits of an aligned ERM/GRC strategy

11. GENERAL SESSION: Cyber Threat Awareness and Creative Strategies for Managing Risk

    2023 Virtual Managed Care Compliance Conference  | February 01, 2023 

    • Learn about the latest trends in the cyber landscape

    • Explore the role of the human element in making or breaking a strong security culture

    • Understand practical suggestions for improving cybersecurity postures with proactive and reactive strategies

12. Managed Care Enforcement: Are You Ready for the Next Wave of Audits, Investigations, and Litigation?

    2023 Virtual Managed Care Compliance Conference  | February 01, 2023 

    • The healthcare world is changing and managed care is the new frontier

    • Regulatory and enforcement agencies continue to scrutinize MA plans and providers for improprieties

    • It is crucial to understand OIG audit findings, enforcement trends, and compliance best practices

13. Compliance Is a Team Sport: Effectively Engaging Employees in the Compliance Program

    2023 Virtual Managed Care Compliance Conference  | February 01, 2023 

    • Learn how one plan engages employees through creative, exciting, and educational compliance events and activities while finding the right balance between having fun and remaining professional

    • Discuss how leadership with an open-door policy can drive a positive culture of compliance and encourage reporting of compliance and privacy concerns

    • See examples of training and educational materials that shift the common perception of compliance saying no to how can we accomplish our goals and remain compliant

14. Third-Party Administrators and FDR Oversight: What Is Your Responsibility as a Health Plan?

    2023 Virtual Managed Care Compliance Conference  | February 01, 2023 

    • Development and incorporation of enforceable Service Level Agreements: Don't leave your health plan metrics and regulatory requirements to vague, subjective contract language

    • Conducting a thorough and meaningful pre-delegation audit: Your TPA's policies and processes directly impact your success

    • Build an effective TPA monitoring and oversight program, including SLA dashboards and protocols: The art of influencing cooperation and collaboration through clear oversight

15. Zero Day Risk to Zero Trust Cyber Strategy

    2023 Virtual Managed Care Compliance Conference  | February 01, 2023 

    • Examine the state of cyber risk today including ransomware and zero-day vulnerabilities

    • Evaluate core components of a Zero Trust approach and step through NIST guidance for Zero Trust

    • Identify key steps to establish a Zero Trust cyber defense program

16. When Compliance Receives Lemons and Makes Lemonade: How Sales Fraud Enhanced a Plan's Reputation with a Regulator

    2023 Virtual Managed Care Compliance Conference  | February 01, 2023 

    • Examine allegations and plan risks through the lens of an effective compliance program

    • Explore decision points and the investigatory approach which led to a successful outcome

    • Share lessons learned that can be leveraged to mitigate sales and marketing compliance risk

17. SNP 2023: Are You Ready?

    2023 Virtual Managed Care Compliance Conference  | February 01, 2023 

    • Understand new requirements to SNP programs from the final rule and updates to the CFR

    • Get ideas for how to implement those new requirements

    • Examine how this may impact audits in 2023

18. Using the Medicare Lifecycle Playbook to Minimize Risks from and during CMS Audits

    2023 Virtual Managed Care Compliance Conference  | February 01, 2023 

    • Ensure compliance with annual and new CMS requirements with the Medicare Lifecycle playbook that covers the 14-month period from Notice of Intent to Apply to offering benefits in the new plan year

    • Gain insight on how to develop and implement your own Medicare Lifecycle playbook, which CMS has recognized as a best practice

    • Develop committees to help prevent, detect, and correct potential noncompliance

    • Utilize Medicare Lifecycle and committee input to optimize risk assessment and audit plan

19. Update on Mental Health Parity in Light of Increased Enforcement and Emerging Regulatory Guidance

    2023 Virtual Managed Care Compliance Conference  | February 01, 2023 

    • Discuss recent DOL and CMS work in Mental Health Parity audits and investigations

    • Address new and emerging Mental Health Parity and Addiction Equity Act (MHPAEA) regulatory guidance

    • Discuss common risk areas, enforcement trends, and lessons learned

20. Medicare, Medicaid, and Federal Exchange/Commercial Risk Areas

    2023 Virtual Managed Care Compliance Conference  | February 02, 2023 

    • Identify compliance risk areas from the OIG work plan

    • Learn how CMS's Program Audit and Enforcement Report can help you identify compliance risks

    • Understand the compliance risks related to the Federal Exchange and other commercial products

21. Better Experiences, Better Outcomes: Understanding the Impacts of 2023 Managed Care Final Rule on Special Needs Plans and Members

    2023 Virtual Managed Care Compliance Conference  | February 02, 2023 

    • Recap new rule, including enrollee advisory committees, HRA changes, and integration opportunities

    • Identify system and policy revisions to address new regulatory requirements

    • Share successful strategies for operational compliance with model of care contractual requirements

22. Virtual Presentation Skills

    2023 Virtual Managed Care Compliance Conference  | February 02, 2023 

    • Discuss critical questions you'll want to ask yourself and decisions you'll make when beginning to design your presentation

    • Learn how you can "see" your audience virtually, even if they all have their cameras off

    • Explore proven and effective ways to connect and engage with your virtual audience

    • Get tips about visuals, pacing, accessibility, and contingency plans

23. What Does the Science of Educational Psychology Teach Us about Compliance Training Best Practices?

    2023 Virtual Managed Care Compliance Conference  | February 02, 2023 

    • Discuss application of established principles of education (Knowles' principles of andragogy)

    • Examine effective principles of compliance training design

    • Analyze key principles of training evaluation (Kirkpatrick's four levels of evaluation)

24. What's So Risky about Risk Adjustment? A Proactive Approach to Incorporating Compliance into Medicare Advantage Risk Adjustment Strategy

    2023 Virtual Managed Care Compliance Conference  | February 02, 2023 

    • Discuss changes in MA risk adjustment (legislative scrutiny, executive oversight, and litigation)

    • Understand legal, compliance, and operational challenges facing MA risk adjustment programs

    • Discuss practical strategies for compliance professionals to mitigate risk

25. Identifying and Investigating Emerging Fraud Trends to Reduce Risk

    2023 Virtual Managed Care Compliance Conference  | February 02, 2023 

    • Identifying emerging fraud trends

    • Investigating fraud schemes and mitigating future risk

    • Creating transparency through the communication of investigative findings