• What skills and strategies make compliance officers efficient and effective?
• Educating Compliance Officers about emerging government audit trends (RAC, OIG, CMS Compliance Program Audits) and strategies for responding
• Augmenting your compliance office to ensure a robust and far-reaching committee
• Pitfalls and Roadblocks: Navigating compliance in large organizations

Medicare Compliance Officer, Cigna Health of Arizona
Corporate Compliance Officer, MedStar Health

Talk with your peers; enjoy some light refreshments all while learning about some new and exciting services and technologies from our exhibitors

• Evaluate the best way to attack fraud at home through a pro/con debate on establishing a separate fraud, waste and abuse department vs. incorporating it into your existing compliance structure
• Using external data to complement claims and other internal information

Fraud Control Program Manager - Compliance, Kaiser Foundation Health Plan of Colorado
Manager, Special Investigations\Internal Audit, Gateway Health Plan
President, Castlestone Advisors

• RADV Audits- current and projected landscape
• Sizing the risk of CMS clawbacks
• Effective risk mitigation strategies
• What if you need to appeal?

EVP,General Counsel & Chief Compliance Officer, Matrix Medical Network
Director of Regulatory Affairs, Blue Cross Blue Shield Association

• How a simple member complaint became a nationwide case, resulting in a 32 million dollar recovery!
• See what strategies were used to ensure that both the public and private sectors work efficiently together to successfully prosecute these offenders
• Gain insight to the creative initiatives used to respond to these fast-moving fraud schemes
• Get ahead of the new tools used by organized crime groups to target Medicare Advantage

Senior Director of Investigations, WellPoint

• Bolster your compliance and legal vocabulary with an in-depth explanation of the inquiry process and related terms
• Comprehensive action plan and curriculum building; communicating industry standards throughout the health plan-provider-patient cycle

SIU Government Program Investigations Coordinator, Health Net
Senior Reimbursement Consultant, Mary Washinton Healthcare

• Augment your in-house agent education and enforcement with strategies used by health plans to ensure that sales, marketing and enrollment are all aware of the latest trends in fraud
• Help your sales and marketing teams develop reports they can run to identify potential fraud
• Hear a case study stemming from a case of fraud Sterling Health dealt with- and how a comprehensive corrective action plan is effectively reducing future fraudulent enrollment!

Talk with your peers; enjoy some light refreshments all while learning about some new and exciting services and technologies from our exhibitors

• What are the latest amendments and how will the effect today's health plans?
• How new settlements and accusations changed the landscape of Medicare Advantage
• Effectively use data validation by auditing information before submission to CMS to capture errors
• Identifying and analyzing dual aspects of Qui Tam exposure: the changing, and more aggressive, attitude of the DOJ and local US Attorney's offices toward intervening in qui tams, and the potential for qui tam plaintiff's counsel asserting creative theories

Assistant Vice President, Carolinas Healthcare System
CIGNA Medicare Compliance Manager, CIGNA Medicare Select
Partner, Burns White

• Get a comprehensive look at the 7 Elements of Compliance Planning; as developed, implemented and policed by Blue Cross Blue Shield of Arkansas:
  • Written Policies/Procedures
  • Compliance Officer/Compliance Committee
  • Effective Training/Education
  • Effective Lines of Communication
  • Enforcement of Disciplinary Standards
  • Effective Internal Monitoring & Auditing
  • Prompt Responses to Detect Offenses & Corrective Action Plans

HIA Compliance Coordinator, Arkansas Blue Cross and Blue Shield

•   Best practices for agent oversight activities
•   Tools for positioning sales oversight for success within your organization
•   Using data compilation to drive meaningful oversight

Vice President, Product Management & Operations, Gorman Health Group

Day One Closing Remarks and Cocktail Reception in the Exhibit Hall

Sponsored by:
Leprechaun

• Gain key insight to the tools health plans use to develop FWA programs
• Hear vital case studies in adopting new and innovative technologies seamlessly into your current processes for enhanced security, transparency and value
• Augment your EHR utilization for increased security with strategies in data mining: save time, cut costs and improve your outlook  by using these tips to navigate the mountains of data we incur daily!

Staff Vice President, Enterprise Business Services, WellPoint
National Compliance, Ethics & Integrity Office, Kaiser Permanente

Talk with your peers; enjoy some light refreshments all while learning about some new and exciting services and technologies from our exhibitors

• Critically examine the steps taken during a special investigation to ensure that you are maximizing your resources and information
• What are the requirements of the SIU to meet major compliance areas of various government programs?
• Share experiences with CMS auditing and other challenge areas!

Senior Investigator, Law Department- Special Investigations, Blue Shield of California

Playing By the Rules:  Winning the Audit Game Through Training

• Discuss CMS rules for HCC Documentation
• Suggestions for how to prepare yourself for a RADV audit

VP Corporate Training and Coding Services, Leprechaun

• Combine your in house and external efforts to combat Pharmacy fraud
• Learn to utilize strategies such as Undercover Buys and Invoice Reviews to fortify security and compliance

Director, SIU Business Assurance Division, Blue Cross Blue Shield of Florida
Compliance Officer, UnitedHealthcare

Speaking opportunities available

• practical processes and practices health plans and industry leaders can use to leverage legal rules of statutory and contract interpretation, attorney-client privilege, documentation and evidence and other legal rules and legal procedures to promote the effectiveness and defensibility of fraud and other compliance efforts, contract enforcement, workforce, provider, vendor and claims management, internal investigations and other key legal and operational practices, performance and risk management activities

Talk with your peers; enjoy some light refreshments all while learning about some new and exciting services and technologies from our exhibitors

• Prevent fraud by using comprehensive encounter data
• Set standards ahead of time to avoid waste and fraud with strategies like prior authorization needs and utilization reviews
• Build a compliance program through utilization controls

Compliance Monitor, Colorado Department of Health Care Policy and Financing

• Learn what a practice do to minimize inadvertent Fraud, Waste and Abuse acts?
• Examine how plans can review and advise the practice to mitigate risk of occurrence?
• How will the assurance of compliance will also positively impact your income stream?

President and CEO, AUK DOK