Picture of 2nd Annual Medicare Advantage Compliance Symposium

2nd Annual Medicare Advantage Compliance Symposium


A Roundtable of Today's Hot Button Issues
May 31, 2012
Washington Plaza Hotel
Washington, DC
United States

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Conference Details:
Our compliance event is now in its second year. This year's agenda is re-researched and revamped to address the current hot button issues of the moment:
  • CMS Quality Initiatives
  • ACOs
  • RADV
  • Best Practices for Appeals and Grievances
  • Correcting Fraud and Abuse
  • Compliance Metrics
  • Tool Evaluation
This conference will provide health plan executives with the strategies they need to minimize the costs of healthcare compliance issues, including combating fraud, eliminating waste, and beating out the abuse.

Further, this year's symposium is co-located with one of the timeliest healthcare conferences going: The 2012 Political Cimate Breakdown: An Executive Medicare Forum. This event will provide healthcare analysis for the election year. Our speakers will unpack each candidate's healthcare proposal and outline what it all means for Medicare in 2013 and beyond!

Our Compliance Symposium will share networking breaks and lunches with the attendees and speakers for the Political Climate Breakdown Forum. Feel free to mix and match sessions from either event to get the most bang for your time and energy.
CEU Information:
Compliance Certification Board (CCB) has approved this program for 5.4 Compliance Certification Board (CCB) Continuing Education Units in one or more of the following areas:
  • Application of Management Practices for the Compliance Professional
  • Application of Personal and Business Ethics in Compliance
  • Written Compliance Policies and Procedures
  • Designation of Compliance Officers and Committees
  • Compliance Training and Education
  • Communication and Reporting Mechanisms in Compliance
  • Enforcement of Compliance Standards and Discipline
  • Auditing and Monitoring for Compliance
  • Response to Compliance Violations and Corrective Actions
  • HIPAA Privacy Implementation
Our Distinguished Speaking Faculty Includes:
Chair:
Casey Dills O'Donnell, Contract Performance Monitor, Government Programs, COLORADO DEPARTMENT OF HEALTH CARE POLICY AND FINANCING

Speaking Faculty:

Casey Dills O'Donnell, Contract Performance Monitor, Government Programs, COLORADO DEPARTMENT OF HEALTH CARE POLICY AND FINANCING
Robert Trusiak
, Assistant U.S. Attorney, U.S. ATTORNEY'S OFFICE
David Karluk, Director, Financial Planning & Analysis, MARY WASHINGTON HEALTHCARE
Carrie Cunningham, Vice President of Business Development, HMS
Mital Panara, Vice President of Revenue Management, FREEDOM/OPTIMUM HEALTHCARE
Jeff Sinaiko, President, SINAIKO HEALTHCARE CONSULTING, A DIVISION OF ALTEGRA HEALTH
Dr. Pariksith Singh, CEO, ACCESS HEALTH CARE
Lynda Benson, Chief Compliance Officer, ACCESS HEALTH CARE
Thomas Figurski, Manager, Special Investigations Unit, GATEWAY HEALTH PLAN
Sue Durham, Manager, Special Investigations Unit, WINDSOR HEALTH PLAN
Tom Hutchinson, Managing Director, SNR DENTON
Continuing Education:
Check back here for information on:
  • Post-conference complimentary webinar
  • Continuing education units
Who Will Attend:
This conference is designed specifically to meet the needs and interests of health plan executives. The conference will also appeal to government agencies, law firms and provider groups. Specifically for C-Level Executives and Vice Presidents, Directors, and Managers of:
  • Accounting
  • Compliance
  • Enrollment
  • Fraud Examination
  • Fraud, Waste and Abuse
  • Marketing
  • Network Operations
  • Quality
  • Risk Assessment
  • Risk Management
  • Risk Adjustment
  • Utilization Management
Current Conference Composition (as of 5/16/12):

Hotel Info:
Washington Plaza Hotel
10 Thomas Circle, N.W.
Washington, DC 20005


We are pleased to announce that the Opal room block is open and we are accepting reservations. Please click on the ONLINE HOTEL RESERVATION link to book your room. The hotel will not accept individual call-ins.
Online Hotel Reservations
  • Rooms are available only to those participants who are registered conference attendees.
  • Rooms will not be guaranteed without a credit card.
  • Rooms are allocated on a first come first serve basis. Room types/rates are subject to availability.
  • The name on the form will be the name of the guest room.
Conference Registration Prices:
Earlybird Rate
(Expires 4/30/12)
Standard Rate
Medicare/Medicare Advantage/Medicaid Health Plans*, Physician Group, Hospital, Government Employees
FREE
$795
* Behavioral Health, Vision Plans, Dental Plans, Radiology, Vascular Access, Rehabilitation Services, Diagnostic Laboratory Testing Services
$795
Service Providers
$1695

Register Now!

Group Discounts:
Register 3 people and receive 10% off ***
Register 4 people and receive 15% off ***
Register 5 people or more and receive 20% off ***

If you'd like to be invoiced, please submit your contact details on the registration page and select "Please invoice me" at the bottom of the page.

If you are interested in sponsorship, exhibiting, or speaking opportunities, please call 212-532-9898 or email information@opalevents.org
* TERMS & CONDITIONS
Subject to approval. To qualify you must be currently employed by a non-vendor company. Eligibility will be verified by conference producer. Opal reserves the right to allocate places and to refuse applications.

* Health plans must be CMS approved as Medicare, Medicare Advantage or Medicaid health plans

***Registrations must be made online on the same date. Discount will be applied after all registrants have been received.


Registration price reflects $100 online discount
Platinum Sponsor
Leprechaun
Gold Sponsors
Altegra Health Matrix Medical Network MedAssurant
Silver Sponsor
HMS
General Sponsor
Trend Source
Media Partners
Bvents.comContexo MediaEHR Outlook Fierce Healthcare Green ConductMedcity MediaOne Med Place  PharmaPhorum
Current Attendees
CEO, Access Health Care Physicians
Chief Compliance Officer, Access Health Physicians
Director, Risk Adjustment, Affinity Health System
President, Altegra Health
Director of Business Development, Altegra Health
Client Relations, Regional Sales, Altegra Health
Vice President, Compliance and Privacy Officer, Altegra Health
VP Sales and Marketing, Altegra Health
Director of Regulatory Affairs, Department of Health Finance and Quality
American Physical Therapy Association
Assistant Director, Regulatory and Payment Counsel, American Physical Therapy Association
Associate Vice President, Health Promotion, Amerigroup Corp
Practice Consultant, AmeriGroup Corp
Quality Management, Amerigroup Corp
Medical Director, Amerigroup Corp
RN Utilization Manager, Amerigroup Corp
Managing Editor, Atlantic Information Services
Compliance Specialist, AultCare Insurance Company
Chief Compliance Officer, Aveta
Director of Government Programs & Products, BlueCross BlueShield
Senior Manager, Internal Audit, BlueCross BlueShield of Florida
QI Manager OneCare, CalOptima
Director of Quality and Utilization, Capital Caring
EVP, Quality and Access, Capital Caring
VP, Organizational Performance, Capital Caring
Practice Administrator, Cardiothoracic Surgical Associates
SVP and Chief Medical Officer, Catholic Health Initiatives
Enterprise Risk / Audit Manager, CIGNA Corporation
Contract Performance Monitor, Government Programs, Colorado Dept of Health Care Policy & Financing
Compliance Director, Denver Health Medical Plan
Program Analyst, Department of Veteran Affairs
Program Analyst, Department of Veteran Affairs
Auditor, DHHS-OIG-OAS
MD, Digestive Health Women Care
Assistant General Counsel, Dimensions Healthcare Systems
CFO, Doctors Inn
Manager, Inpatient Dialysis, Erie County Medical Center Corporation
Quality Control Nurse, Erie County Medical Center Corporation
Manager, Special Investigations/Internal Audit, Gateway Health Plan
Medicare Compliance Specialist, Gateway Health Plan
Director, Medicare Administration, Gateway Health Plan
Administrative Assistant, Gateway Health Plan
Medicare Compliance Coordinator, Geisinger Health Plan
Administrator, Medication Safety / PI, Georgetown University Hospital
Assistant Director, Nursing Quality, Georgetown University Hospital
Lead Research Scientist, George Washington University
Research Assistant, George Washington University
Physician/Managing Partner, Global Rehabilitation Medical
Medicare Compliance Officer, Harvard Pilgrim Health Care
Vice President, Senior Programs, Harvard Pilgrim Health Care
Manager Case Management, HCR ManorCare
National Account Manager, HCR ManorCare
Manager Case Management, HCR ManorCare
Sr. Director, Health and Wellness Coaching, Care Coordination, Health Plus
VP, HealthCare Partners of Nevada
SVP, Government Affairs, HealthSpring
Vice President For Business Development, HMS Managed Care Services
Senior Manager Medicare Programs Administration, HMSA
Administrative Director Department of Surgery, Howard University Hospital
Departmental Executive Director, Howard University Hospital
Sr. Director Revenue Cycle HIS, Howard University Hospital
Director of CDI and Data Integrity, Howard University Hospital
Director of HIM, Howard University Hospital
Chief Compliance Officer, HSC Health Care System
Director, Federal Public Affairs, Humana
Manager, Federal Public Affairs, Humana
Compliance Manager, Independence BlueCross
Executive Director, Infinity Care of East Los Angeles
VP of HS and Member Services, Inter Valley Health Plan
Administrative Fellow, Johns Hopkins Health System
Risk Manager, Johns Hopkins Health System
Administrative Fellow, Johns Hopkins Medicine
Administrative Fellow, Johns Hopkins Medicine
Administrative Fellow, Johns Hopkins Medicine
Sr. Clinical Compliance Practice Leader, Kaiser Permanente
Senior Manager, Provider Contracting, Kaiser Permanente
Intern, Kaiser Permanente
Intern – Contracting, Kaiser Permanente
Executive Associate, LA Care Health Plan
Director of Business Development, Leprechaun
Director, Financial Planning & Analysis, Mary Washington Healthcare
Director, Performance Measures, Medica HealthCare Plans
Administrator, Medical Interventions
Billing Assistant, Medical Office Dr. David T Sicard
Direct Care RN, Nursing Legislative Council Member, MedStar Georgetown University Hospital
Direct Care RN, Nursing Legislative Council Co-Chair MedStar Georgetown University Hospital
Neurosurgical Inpatient Coordinator, MedStar Georgetown University Hospital
RN, MedStar Georgetown University Hospital
RN Clinical Case Manager, MedStar Georgetown University Hospital
Executive Assistant, MedStar Surgery Center
President, MedStar Surgery Center
Chief Compliance Officer, Mountain View Hospital System 
Senior Compliance Representative - Medicare Part D Compliance Officer, National Rural Electric Cooperative Association
Director Pharmacy Program, National Rural Electric Cooperative Association
Sr. Representative-- Medicare D Programs, National Rural Electric Cooperative Association
Dr., Oncology Medical Park, Anne Arundel Medical Center
Director of Utilization Management & Case Management, Pacific Health Corporation
President, Pediatric Specialists
Reimbursement Coordinator, Piedmont Community Services Board
Finance Director, Piedmont Community Services Board
QA Manager, Piedmont Community Services Board
Medicare Compliance Officer, PrimeTime Health Plan
Public Health Advisor, SAMHSA
Compliance Specialist, Security Health Plan
Medicare Part D Manager, SelectHealth
Program Director, Senior Health Insurance Assistance Program
Managing Director, SNR Denton
Compliance Officer, Transamerica
Sr. Program Manager, UMWA Health & Retirement Funds
Assistant Professor of Surgery, Uniformed Services University of the Health Sciences
Medicare Compliance Officer, Universal Health Care
Director, Medicare Compliance, Universal Health Care
Assistant US Attorney, US Attorney’s Office
PeriOp Finance Director, VCU Medical Center
Director of Managed Care, Virginia Cancer Specialist
State Manager of Managed Care, Virginia Oncology Association
Vice President Corporate Finance, Visiting Nurse Service of New York
Manager, Medicare Compliance Audit & Monitoring, Wellcare Health Plans
Compliance Manager, WellMed Medical Management
Healthcare Consultant, WellMed Medical Management
Physician Business Manager, WellMed Medical Management
Utilization Management Analyst, WellMed Medical Management
Administrative Director, West Bergen Mental Healthcare
Manager, SIU, Windsor Health Group
Thursday, May 31, 2012
8:00 am
Continental Breakfast & Registration
9:00 am
Opal Events' Welcome
9:05 am
Chair's Welcome & Audience Demographics

Contract Performance Monitor, Government Programs, COLORADO DEPARTMENT OF HEALTH CARE POLICY AND FINANCING
9:20 am
Keynote Address: How to Identify and Manage False Claims Act Exposure in a Part C Plan

Speaker:
Assistant U.S. Attorney, U.S. ATTORNEY'S OFFICE
10:05 am
What it takes to make your prospective assessment program compliant as a medical expense

Managing Director, SNR DENTON
10:50 am
Morning Refreshment & Networking Break
11:20 am
Audit Best Practices
  • Audits: Current and projected landscape
  • Sizing the risk of CMS clawbacks
  • Effective risk mitigation strategies
  • What if you need to appeal?
Speaker:
Director, Financial Planning & Analysis, MARY WASHINGTON HEALTHCARE
12:05 pm
Moving the Audit and Compliance Function Upstream
  • Compliance and Fiscal Integrity
  • Pre-pay solutions
  • Potential results of preliminary investigations
Speaker:
Vice President of Business Development, HMS
12:50 pm
Luncheon
1:50 pm
Compliance of Risk Adjustment - RADV Audit 101
  • How to avoid penalties for inaccurate data
Speaker:
Vice President of Revenue Management, FREEDOM/OPTIMUM healthcare
President, sinaiko healthcare consulting
2:35 pm
Panel Discussion
Best Practices for Clinic Inspections: Ferreting Out Bogus Provider Groups in Your Network
  • Why you should be doing regular inspections – and how to do them effectively
  • From an SIU perspective, clinical perspective, and coding perspective
Panelist:
CEO, ACCESS HEALTH CARE
Chief Compliance Officer, ACCESS HEALTH CARE
3:20 pm
Utilization Management: Strategies to Ensure Compliance with Quality of Care Activity
Ensure compliance with Health Reform Policy and activities:

  • Develop quality measures
  • Establish benchmarks to measure utilization management activity
  • Integrate implementation activities using evidence-based design
Speaker:
Contract Performance Monitor, Government Programs, COLORADO DEPARTMENT OF HEALTH CARE POLICY AND FINANCING
4:05 pm
Afternoon Refreshment & Networking Break
4:30 pm
Case Studies
Fraud & Abuse Study #1
Case study involving the billing of External Counter Pulsation.  Case study will include how to identify aberrant billing providers, resources that can be used to validate your case, actions taken (including preventative measures to avoid that this situation reoccurs), provider reaction and how to deal with it, and resolution measures to consider in resolving the case.

Speaker:
Manager, Special Investigations Unit, GATEWAY HEALTH PLAN

Fraud & Abuse Study #2
Miami physician identified by Windsor as a potential fraudulent provider. Case study will include how he was identified, actions taken (including preventative measures to deter this situation occurring again), provider reaction and ultimate resolution of the case.

Speaker:
Manager, Special Investigations Unit, WINDSOR HEALTH PLAN
6:00 pm
Conference Adjourns; Cocktail Reception immediately to Follow
Service Providers
$1,695.00
:
Behavioral Health, Vision Plans, Dental Plans, Radiology, Vascular Access, Rehabilitation Services, Diagnostic Laboratory Testing Services
$795.00
:
Medicare/Medicare Advantage/Medicaid Health Plans*, Physician Group, Hospital, Government Employees
$795.00
:
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