Monday, October 2

8:15 – 9:30 am
General Session

Advice to Physicians From a Physician– Compliance Officer: Lessons Learned About Medicare and the Practice of Medicine
Cynthia Boyd, Assoc. VP, Chief Compliance, Privacy & Security Officer,
Rush University Medical Center

9:30 – 10:45 am
General Session

Ethics: Moral Dilemmas and Doing the Right Thing
Urton Anderson, Associate Dean for Undergraduate Programs and Clark W. Thompson Jr Professor in Accounting Education, McCombs School of Business

Document 1

• Be more confident in addressing common and uncommon ethical dilemmas faced by compliance professionals
• Be better able to manage the tension of working in an organizational
  team while holding the others in the organization accountable
• Learn strategies to implement when facing unethical or inappropriate decisions
• Learn to partner with others in your organization to implement and enforce ethical decisions

11:00 am – 12:00 pm
Breakout Sessions

101 Claims Denial Management: What Are Third Party Payers Really Telling You about Your Documented Quality-of-Care and Compliance?
Betty Bibbins, President and Chief Medical Officer, DocuComp LLC Healthcare

Document 1

• Updating attendings and hospitalists to the Prospective Payment System (PPS) used by Medicare and other third-party payers to reimburse for acute, facility-based patient care
• Understand how third-party payers differ in the implementation of reimbursement for similar types of patient care, such as Outpatient Observation (OOS) vs. Acute Inpatient Care
• Updates on appropriate documentation of severity-of-illness to justify utilization-of-services

102 Current Issues in Stark II Compliance
Steve Ortquist, Senior Vice President Ethics & Compliance, Tenet Healthcare Corporation

No handouts available

• Basics of the Stark II law and regulations
• Open Questions in the Stark II Regulations
• Strategies for Stark II Compliance

103 Orders from Chaos: Controlling Costs and Confusion in Internal Investigations
Patrick Marion, Partner, Compliance Concepts, Inc.
Kathleen Merlo, Director, Saint Louis University

• Controlling the investigation: How to inform and get information without breaching confidentiality or creating a firestorm
• Decisions within the institution: Involving administrators in decision-making
• The roles of external experts: Determining when to involve consultants and external counsel and defining their roles

1:30 – 2:30 pm
Breakout Sessions

201 Understanding “Incident To” Rules
Helen Hadley, President, VantagePoint HealthCare Advisors

Document 1

• CMS Definition of “incident to”
• Non-physician practitioners to whom this is relevant
• Supervision requirements

202 Internal Investigations in the Physician Practice
Al Josephs, Senior Director of Policies and Training, Tenet HealthCare Corporation

• The current enforcement environment
• Recent political developments
• Practical approaches to internal investigations

203 Pay for Performance—Will It Impact Physician Services?
Wilma Acosta, Associate Director, Protiviti, Inc.
Richard Prebil, Foley & Lardner

• Financial pros and cons of incentives programs—incentives vs. gainsharing vs. STARK. Don't confuse the legal jargon. Is the program worth it? What's in it for you?
• Reporting expectations—can you meet the reporting requirements?
• Steps for successful implementation—you can do this. But at what cost?
• Compliance risks—red flags!

2:45 – 3:45 pm
Breakout Sessions

301 The New Medicare Appeals Process and Strategies for Successful Appeals
Andrew Wachler Esq., Principal, Wachler & Associates, P.C.

• Overview of the new Medicare appeals process, including the early presentation of evidence requirement
• Discussion of past successful appeal strategies for third party payer audits and how they can be utilized in the new process
• Discussion of successful proactive compliance strategies to assist physician practices in avoiding third party payer audits

302 Whistleblowers, Corporate Compliance and Liability and What It Means for Physicians and Hospitals
Gabriel Imperato, Managing Partner, Broad and Cassel

Document 1

• A review of historical corporate criminal convictions and civil liability and the imposition of corporate integrity agreements and the proliferation of compliance programs in the health care industry and its ramifications for physicians and hospitals
• A review of developments pursuant to recent corporate scandals such as Enron, Arthur Andersen and Health South, the passage of the Sarbanes-Oxley Act, the Sentencing Guideline Amendments of 2004 and Department of Justice prosecution policies against business organizations
• An examination of several case studies involving corporate liability and how it resulted in criminal and civil liability for physicians and physician group practices and medical staff members and for hospitals

303 Fraud and Abuse Concern for Electronic Prescribing and Electronic Health Records
Peter Hoffman, Partner, Garfunkel, Wild & Travis, P.C.
Jonathan Leviss, Medical Director, Sentillion

Document 1

4:00 – 5:00 pm
Breakout Sessions

401 HIPAA Privacy and Patient Identity Theft
Wynelle Paige, Compliance Advisory Coalition

Document 1

• Real-life case stories
• Increased internal awareness
• Update of Minimum necessary guidelines

402 Institutional Ethics: Building a Policy and Procedure for Disclosures of Medical Errors to Patients
Gary Chiodo, Director, OHSU Integrity Office, Oregon Health & Science University

Document 1

• Establishment, authority, and operation of an institutional ethics committee
• Conflicting personal and professional values related to termination of pregnancy, contraception, withholding/withdrawing of life-sustaining treatments, and physician-assisted suicide
• Direct versus indirect involvement in the provision of services

403 Educating your Physicians
Al Josephs, Senior Director of Policies and Training, Tenet HealthCare Corporation
Carrie Prante, Regional Compliance Director, Tenet Healthcare Corporation

Document 1

Tuesday, October 3

8:15 – 9:15 am
General Session

Health Care Fraud Investigations
Sean McKenna, Assistant United States Attorney, U.S. Attorney’s Office Northern District of Texas

Document 1

• The focus of the presentation will be on the investigation and prosecution of physicians
• The topics to be discussed will include: False Claims Act cases and settlements; investigative tools and procedures; and problematic financial relationships

9:15 – 10:30 am
General Session

Compliance Effectiveness in the Physician’s Office
Kimberly Brandt, Director of Program Integrity, Centers for Medicare & Medicaid Services

10:45 – 11:45 am
Breakout Sessions

501 Reasonable & Necessary: How Proactive Physicians Protect Themselves & Their Patients Against Adverse Payor Actions
Alan Goldberg, Attorney & Counsellor at Law

Document 1, Document 2, Document 3, Document 4,
Document 5, Document 6, Document 7, Document 8, Document 9

502 Capturing New Revenues: The Opportunities and Challenges
Robert Homchick, Davis Wright Tremaine LLP

Document 1

• Where are physicians finding opportunities for new revenues?
• The range of models physicians can employ to exploit these opportunities
• How to structure transactions in light of the regulatory landscape

503 Physician Practice and HIPAA
Marti Arvin, Privacy Officer, University of Louisville

Document 1

• The HIPAA enforcement rule and what it could mean to physician practices
• How to conduct an ongoing risk assessment as required by the security rule
• How to handle a HIPAA complaint in your practice

11:45 – 1:00 pm
Lunch (Speaker)

Fraud and Abuse Update for Physicians: How Docs Get in Trouble Without Really Trying
Arthur Di Dio, Trial Attorney, Civil Fraud Section, U.S. Department of Justice

• Increased use of civil monetary penalty and other types of actions against physicians
• Financial relationships with hospitals, pharma, and device vendors
• Quality of care/unnecessary care

1:15- 2:15 pm
Breakout Sessions

601 Practical Tips for Dealing with Drug Reps in the Physician Practice
Teresa Bivens, Compliance Education Coordinator, University of Louisville, Office of Compliance

Document 1, Document 2

• The PHARMA Code not only affects pharmaceutical representatives, but physician practices as well—are you being compliant?
• Learn more about the PHARMA Code and how it affects providers in the physician practice
• Practical “dos” and “don’ts” and FAQs for dealing with pharmaceutical representatives in your practice

602 Clinical Trial Billing Process Implementation— From Coverage Review to Billing
Lisa Murtha, Managing Director, Huron Consulting
Ryan Meade, Meade & Roach, Chicago, IL

• How to manage physician practice compliance risks in medical research billing
• Understanding compliance steps physicians should take when a practice decides to conduct medical research
• The role of contracting in clinical trials billing compliance

2:30 – 3:30 pm
Breakout Sessions

701 Understanding the Focus of Enforcers in Health Care Fraud
Steve Morreale, Principal, Compliance & Risk Dynamics

Document 1

• Overview of investigations—for OIG, FBI and Medicare Fraud Control units
• Anatomy of an investigation
• Discussion of the use of the OIG Workplan for physician practices

702 Stop Spinning your Wheels and Get Traction with a Physician-Supported, Risk-Targeted, Compliance/Audit Program
Beverly Gamblin, Compliance Auditor, Indiana University School of Medicine
Michael Jackson, Assistant Compliance Officer and Privacy Officer, Indiana University School of Medicine

Document 1

• Data collection and data analysis
• Physician risk profiling and physician audit priority
• Corrective action follow-up

703 Practical Solutions to the Challenges Facing Physicians’ Office Billing Departments
David Haier, University Physician Associates of New Jersey
Susan Blackwell May, Director of Corporate Compliance, American Health Network, Inc.

Document 1, Document 2, Document 3