2019 Compliance Institute (CI)

76. Managed Care Fraud: Enforcement and Compliance

    2019 Compliance Institute (CI)  | Presenter(s): Megan Tinker, Banjamin D. Singer  | April 09, 2019 

77. Women in Cybersecurity: Shattering the Career Mystique

    2019 Compliance Institute (CI)  | Presenter(s): Maliha Charania, Anahi Santiago, Monique Hart, Dana Carter  | April 08, 2019 

    • Cybersecurity is one of the best technology jobs rated by U.S News & World Report’s “Best Technology Jobs.” However, Forbes Magazine states about 10% of the cybersecurity workforce is made up of women

    • An expert panel will address common misconceptions young people (including women) have about information security careers and the skills required for success

    • Important support systems, mentoring and ways to encourage women in healthcare information security careers will be discussed. Questions from the audience will be addressed by the panel

78. When Compliance Isn't the Only Hat You Wear: The Art of Allocation of Time and Resources While Maintaining an Effective Compliance Program

    2019 Compliance Institute (CI)  | Presenter(s): Tomi Hagan, Gary Jones  | April 08, 2019 

    • Facing the reality that Compliance Officers in smaller organizations may have additional responsibilities

    • Interactive discussion on prioritization of risks and initiatives to maximize efficient use of time and resources

    • Promotion of a culture of compliance and program awareness when compliance isn’t your only job

79. What Do Carnegie Hall and Good Security Incident Response Plans Have in Common: To Get There You Have to Practice, Practice, Practice!

    2019 Compliance Institute (CI)  | Presenter(s): Joseph Dickinson, Sheryl Vacca  | April 08, 2019 

    • We will discuss the importance of an Incident Response and how to develop one

    • Discuss table top exercises, how they improve incident response plans and how to conduct one

    • We will lead the participants through an abbreviated table top exercise

80. Will CMS Turn Down the Volume? Patient-Driven Payment Model (PDPM) and the Effort to Replace RUGs

    2019 Compliance Institute (CI)  | Presenter(s): Mark Reagan, Joseph Greenman  | April 08, 2019 

    • Historical overview of SNF PPS payment methodology and the current Resource Utilizations Groups, Version 4 (RUG-IV) for paying SNFs per diem rates for resident services with a review of associated compliance trends. Side-by-side comparison of RUGs with PDPM in an effort to impart understanding of how SNF Medicare payments will change when providing care to residents with varying care needs

    • In depth analysis of proposed new PDPM case-mix index components, underlying assessment criteria for each that will affect individual resident reimbursement level determinations, additional resident data sources used by CMS to produce resident reimbursement, and review how reimbursement compliance will change if CMS adopts PDPM in its current form. Update on SNF therapy requirements and the CMS proposed 25% limit of a SNF resident’s therapy minutes by PT, OT, or SLP

    • Analysis of the impact of alterations of resident assessments and other elements of PDPM, including new required uses of multiple ICD-10 diagnosis codes on the Minimum Data Set (MDS) patient assessment. Evaluation of how PDPM will impact healthcare fraud and abuse laws such as the false claims act including a look at how MDS section GG will become central to payment scoring structure

81. Year One of a Compliance Journey: A First Year Under a CIA - Tips to Prepare for and Implement Best Practices for Your CIA

    2019 Compliance Institute (CI)  | Presenter(s): Steve Pratt, Tony Krawat  | April 08, 2019 

    • Attendees will get a broad overview of one organization’s (Mercy’s) journey as it navigated the first-year requirements of a CIA. We will cover the evolving requirements of a CIA, how organizations can plan for year 1, and how to prepare governance and leadership

    • Attendees will review how to prepare Certifying Employees so they are not surprised by and can be comfortable providing the Management Certification. We will review steps Mercy took to create a process to identify, investigate, and cure potential risks

    • The presentation will also address how to change the culture of your organization. We will provide tips and identify best practices to change the culture of an organization, starting at the top with the board and CEO, and reaching down to entry‑level workers

82. You Can Lead a Horse to Water and You Can Make It Drink: The Role of the Work-Plan In Developing and Implementing POCs in Behavioral Health

    2019 Compliance Institute (CI)  | Presenter(s): Kristine Koontz, Victoria Hoshower, Michelle Seidle  | April 08, 2019 

    • Describe fundamental process and content elements needed within a Behavioral Health Plan of Correction (POC), from targeted individual/event level responses to systematic organization-wide improvements

    • Provide tips and resources on strategically engaging interdisciplinary teams to maximize organizational resources and minimize disruption of services while developing and implementing the POC Work-Plan

    • Share lessons learned and provide practical quality management methodologies and take-home tips to ensure “how good by when” POC implementation and methods to preserve gains across time

83. You Don't Know What You Have Until It's Gone, and Then It Is Too Late: The Benefits of a Data Management Audit

    2019 Compliance Institute (CI)  | Presenter(s): Marti Arvin, Don Ahart  | April 08, 2019 

    • Why a data management audit is the first necessary step to understanding your data vulnerability

    • Recommended steps in auditing your data management program, including steps to verify data ownership, categories, security, location, traceability, and criticality

    • How a data management audit adds value to an organization’s disaster recovery program, incident response planning, and risk assessments

84. Mergers & Acquisitions During a Time of Healthcare Transformation

    2019 Compliance Institute (CI)  | Presenter(s): Andrea Ekeberg, Shirley Qual  | April 08, 2019 

    • Due Diligence: How to get Compliance a seat at the table? Scope of review—what to ask for and look for? How to highlight identified compliance risks?

    • Integration: Where to start—sign vs. close? How to prioritize—people, process, technology? Who are your partners?

    • Case Examples: Lessons learned, business model considerations, sample templates and tools

85. Anatomy of an Attack: Key Security Trends

    2019 Compliance Institute (CI)  | Presenter(s): Kevin Dunnahoo  | April 08, 2019 

    • Discover key trends in healthcare cybersecurity, breaches, costs to the industry, and the overall motivation for these attackers to gain access to sensitive information including PHI

    • Describe the anatomy of attacks and security breaches occurring in healthcare, using real world examples and scenarios, covering attacker’s processes for gaining a foothold, privilege escalations, lateral network movement, and data exfiltration tactics

    • Recommend key cybersecurity controls and areas of focus for compliance personnel to team with information security personnel to jointly manage the risks to your organization in a proactive manner

86. Ask the Stark Law Professionals

    2019 Compliance Institute (CI)  | Presenter(s): Robert Wade, Lester Perling, Daniel Melvin  | April 08, 2019 

    • General overview of the Stark Law

    • Bring your Stark Law questions and the panel will analyze and discuss “real time” potential Stark Law risks

    • “Live” answers to your Stark Law operational questions

87. Compliance Culture Case Studies

    2019 Compliance Institute (CI)  | Presenter(s): Margaret Scavotto, Scott Gima  | April 08, 2019 

    • Federal guidance makes clear that an effective compliance program requires a strong culture to support it. Practical experience also teaches us that culture will make or break a compliance program

    • Using court cases and news headlines, we will walk through real-world fact patterns and decisions that shaped both negative and positive cultures, and their impact on compliance

    • We will brainstorm steps providers can take to promote a positive culture of compliance, as well as strategies to counteract negative culture forces. Approaches will include board involvement, staff training, accountability and incentives, and more

88. A Compliance Case Study from the Trenches with Current and Former DOJ Prosecutors

    2019 Compliance Institute (CI)  | Presenter(s): David Schumacher, Abraham George  | April 08, 2019 

    • Using a real-life case study, DOJ Attorney Abraham George and former healthcare fraud prosecutor David Schumacher will discuss the numerous and challenging compliance issues that arose in a recent federal healthcare fraud investigation

    • Topics to be discussed include arrangements with physicians that potentially violate the Anti-Kickback Law, interactions with insurance companies that give rise to fraud charges and false claims, and practices that implicate HIPAA criminal liability

    • Discuss current DOJ healthcare enforcement priorities and trends

89. ACO Compliance Program Implementation When You Are Not All In the Same Family

    2019 Compliance Institute (CI)  | Presenter(s): Jennie Henriques, Donna Schneider  | April 08, 2019 

    • Demonstrate how to introduce, evaluate, and maintain an effective compliance education program when participants are from different organizations and therefore have various levels of integration and attention to the ACO

    • Lessons learned on how to implement an auditing program when participants are from multiple organizations

    • Identify best practice for implementation of a Response Line and Policies for this type of hybrid ACO organization

90. Blockchain Technology: Move Fast and Break Things Reconsidered

    2019 Compliance Institute (CI)  | Presenter(s): Scott Streibich  | April 08, 2019 

    • Blockchain technology is attracting investment and interest in a solution to serve the healthcare industry; yet few professionals understand how they function

    • Learn how blockchain technology operates and understand the implications for regulatory compliance related to patient information access, privacy and data retention

    • Take away a risk analysis framework to share in your organization to educate others involved in blockchain development and adoption before problems arise

91. Communicating with Your Audit and Compliance Committee from Both a Compliance Officer's and Board Member's Perspective

    2019 Compliance Institute (CI)  | Presenter(s): Jodi Laurence, Jose Perdomo  | April 08, 2019 

    • What information should be communicated to the audit and compliance committee?

    • How to engage your committee

    • How to be an effective committee member

92. Compliance at the Point of Sale

    2019 Compliance Institute (CI)  | Presenter(s): C.J. Wolf, Darryl Rhames  | April 08, 2019 

    • Setting up internal controls to ensure the accuracy and reliability of captured financial information, including patient payments (satellite clinics/hospitals) and retail sales (nutritional services)

    • Implementation of physical and system controls to safeguard assets and setting up payment collection point for clinical front desk operations and retail cashier locations

    • The adoption of meaningful training for registration clerks and cashiers

93. Conducting a Behavioral Health Risk Assessment

    2019 Compliance Institute (CI)  | Presenter(s): Tim Timmons, Todd Jacobson  | April 08, 2019 

    • How to conduct a compliance risk assessment for behavioral health providers

    • Recommendations for identifying, prioritizing and mitigating behavioral health compliance and privacy risks

    • How to ensure that both HIPAA and 42 CFR Part 2 requirements are addressed in the risk assessment

94. Creating a Compliance Plan in the New Post-Acute World

    2019 Compliance Institute (CI)  | Presenter(s): Barb Duffy, Donna Thiel  | April 08, 2019 

    • Risks are changing with new payment models and inter-operability; what risks should you consider building into your compliance plan

    • OIG Work Plan monthly updates; Do you update your plan monthly? How do you incorporate this new information?

    • Are you prepared for the future? How does your plan incorporate the new Requirements of Participation?

95. Facing an Extrapolation? Steps for Checking the Statistical Approach

    2019 Compliance Institute (CI)  | Presenter(s): Andrea Merritt, Frank Castronova  | April 08, 2019 

    • Overview of the types of sampling techniques, sampling errors, and biased sampling

    • Addressing the calculations behind the extrapolations and determining whether there is a need to question the statistical approach to the calculation to ensure you do not overpay

    • Presentation of real life investigations, sampling, and extrapolations. Review take-aways to ensure proper sampling and extrapolation during investigations

96. Data Analytics and Risk-Based Methodologies in Refreshing Revenue Compliance Auditing & Monitoring

    2019 Compliance Institute (CI)  | Presenter(s): Andrew Kins, Kate Welti  | April 08, 2019 

    • Demonstrate how a risk-based approach to revenue compliance auditing and monitoring targets critical resources at the most important risks

    • Show real-world examples of risk-based data analytics in revenue compliance (i.e. Evaluation and Management services)

    • Exhibit how data visualization bridges the gap between challenging data interpretation and consistent organizational understanding of compliance risk

97. OIG Developments 2019

    2019 Compliance Institute (CI)  | Presenter(s): Greg Demske, Sue Murrin, Brian Ritchie  | April 08, 2019 

    • Hear from senior OIG officials about OIG’s recent work, including the 2018 National Takedown

    • Learn about enforcement trends, industry-specific findings, and developments related to opioids work

    • Discuss OIG’s current priorities

98. Long-Term Care Requirements of Participation Compliance Responsibilities

    2019 Compliance Institute (CI)  | Presenter(s): John Dailey, Sean Fahey  | April 08, 2019 

    • Benefits of a long-term care compliance program

    • Building a compliance program on the long-term care requirements of participation compliance responsibilities

    • Steps to ensure ongoing compliance program effectiveness

99. Navigating Behavioral Health Risks and Confidentiality Tough Spots

    2019 Compliance Institute (CI)  | Presenter(s): Purvi Shah Khare, Judith Jobe, Kelly Epperson  | April 08, 2019 

    • This presentation will examine the top compliance risks for behavioral health providers, including lessons learned from recent OIG and DOJ settlement reports and risk areas identified in the current OIG Work Plan

    • Steps for building an action plan for risk prevention and mitigation will be reviewed. Strategies for mitigating high risk behavioral health areas, such as telehealth, psychotherapy, and opioid treatment program services will be highlighted

    • 42 CFR Part 2 “tough spots” will be identified and examined with best practices discussed. These problematic areas include payment issues, coordination of care, mandated reporting, duty to warn situations, and law enforcement requests for information