Monday, October 17

8:15 – 9:15 am | GENERAL SESSION

NY—Tales from the Trenches— Onsite Visits to Physician Offices

Carol Booth, CHC, Health Systems Specialist 3, Bureau of Compliance, Office of Medicaid Inspector General

presentation, handout 1, evaluation survey

9:30–10:30 am | GENERAL SESSION

Navigating Through the Pot Holes: Compliance Challenges with Physicians

Robert H. Ossoff, DMD, MD, CHC, Assistant Vice-Chancellor for Compliance and Corporate Integrity, Maness Professor of Laryngology and Voice, Vanderbilt Medical Center

presentation, evaluation survey

• Tips on communicating with physicians and helpful hints on cultivating physician champions
• Strategies to deal with physician challenges brought about by the adoption of an EMR
• Suggestions for dealing with low performers and for creating incentives and/or penalties to stimulate performance improvement

11:00 am–12:00 pm

101 – Got a Match? Tools for Sanction Check Due Diligence in Physician Practice Environments

Robin L. Wilcox, CPA, CHC, CCEP, Institutional Compliance Officer, University of Louisville
William A. Metcalf, CHC, CCEP, CIA, Senior Compliance Analyst, University of Louisville

presentation, handout 1, handout 2, handout 3, handout 4, handout 5, evaluation survey

• Discuss federal and state sanction check requirements, including potential impact of the new PPACA
• Consider factors for evaluating exclusion list information and selecting vendor supported programs
• Receive practical tools to verify potential matches identified and document due diligence process

102 – Outsourced Billing Arrangements: What You Need to Know to Reduce Risk

Karie Rego, Special Counsel, Sheppard Mullin Richter & Hampton

presentation, evaluation survey

• Creating better agreements for outsourced billing
• Compliance training and auditing under outsourced billing arrangements
• Handling errors and liability when billing mistakes happen

12:00–1:00 pm | Networking Lunch

1:00–2:00 pm

201 – Auditing & Monitoring with Management Results: Effective Program on a Shoe-string

Regina F. Gurvich, MBA, CHC, Chief Compliance Officer, University Physician Associates of NJ, Faculty Practice Plan of UMDNJ, Newark
Jean Jurek, MS, RHIA, CPC, Professor, Erie Community College, Health Information Technology Program

presentation, handout 1, evaluation survey

• Audit strategies: Practical concerns of implementing an effective risk assessment and audit structure
• Auditing & monitoring: Mitigating budget and staffing constraints by effective prioritizing the risks
• Communicating results & findings: Governance as a risk area

202 – EHR Implementation and Compliance in Physician Practices: Challenges and Solutions

Ranjan Sachdev, MD, MBA, CHC, Director Orthopaedics, Central Kansas Medical Center

presentation, evaluation survey

• Compliance risks of EHR implementation challenges in physician practices will be highlighted
• Billing risks associated with EMR generated documentation like copying and pasting (aka cloning), exploding templates, authorship and integrity issues
• What risks might accompany meaningful use attestations?

2:30–3:30 pm

301 – Enforcement Considerations for Physician Practices: Investigating Physician Misconduct Without Ruining the Case

Edgar Bueno, Assistant United States Attorney, Southern District of Georgia
José A. Tabuena, Vice President, Compliance and Risk, Texas Health Physicians Group

presentation 1, presentation 2, evaluation survey

• Types of compliance failures that lead to criminal, civil, or administrative enforcement
• The nuts and bolts of investigating a case of potential physician misconduct
• Approaching issues involving clinical standards of care

302 – Fundamentals of Physician Coding for Non-Coders

Robert A. Pelaia, Senior University Counsel for Health Affairs, University of Florida
Bess Ann Bredemeyer, Director Compliance Services, McKesson Revenue Management Solutions

presentation, handout, evaluation survey

• The basics of procedural (CPT) coding including Evaluation & Management (E&M) coding
• General review of diagnosis (ICD-9 and ICD-10) coding

4:00–5:00 pm

401 – Hot Topics and "Risky Business" for Raising a Red Flag without Throwing in the Towel

Kelly Loya, CPC-I, CPhT, CHC, Managing Consultant, Sinaiko Healthcare Consulting, Inc
Kristen Taylor, CPC, Senior Consultant, Enterprise Risk Services, Internal Audit and Compliance, Sinaiko Healthcare Consulting, Inc.

presentation, evaluation survey

• Common clinical documentation deficiencies causing negative findings in audits
• Incident-to v. split shared visits v. teaching physician documentation techniques
• The power of signature: recent trends and regulations surrounding the importance of the "complete" medical record

402 – Conflicts, Conflicts, Conflicted

Annette Ciavarella, JD, Former Chief Compliance & Ethics Officer, North Canton Medical Foundation

presentation, handout 1, evaluation survey

• Conflicts with consultants
• Hidden conflicts of interest
• Workplace conflict resolution

Tuesday, October 18

8:15–9:15 am | GENERAL SESSION

Trends in Health Care Fraud Enforcement

Sean R. McKenna, Assistant U.S. Attorney, Department of Justice

presentation, handout 1, evaluation survey

• Physician risk areas that could result in fraud investigations
• How the government investigates fraud allegations
• Compliance efforts that could reduce or minimize the adverse effects of fraud investigations

9:30–10:30 am | GENERAL SESSION

Criminal and Civil Liability for Overpayments

Gabriel L. Imperato, Managing Partner, Broad and Cassel

presentation, evaluation survey

• The statutory obligation to return a "known overpayment" and its application in criminal and civil enforcement proceedings
• The basis for liability for "retention of a known overpayment" under the United States False Claims Act
• The "identification" of a "known overpayment" and the time requirements for disclosure and return of the overpayment

11:00 am–12:00 pm

501 – Operating a Compliance Program on a Shoestring Budget

Sarah Elisabeth Curi, JD, MPH, Principal, Milestone Law Group

presentation, evaluation survey

• Explore proven strategies for maximizing limited time, staffing, and funding
• Learn what the government really expects from individual and small group physician practices
• Proactively respond to new regs and initiatives (e.g., HI -TECH, RAC audits, HI PAA fines)

502 – How to Do Your Own Data Mining to Keep the Government Contractors Out of Your Physician Practices

Andrei Costantino, MHA, CFE, CHC, CPC-H, CPC, Director of Organizational Integrity, Trinity Health

presentation, evaluation survey

• Step-by-step instructions on developing physician benchmarking and scorecard reports
• Examples on using data to perform risk assessments and sampling designs
• Discussion on how to implement an effective physician practice auditing and monitoring strategy

12:00–1:00 pm | Networking Lunch

1:00–2:00 pm

601 – Navigating the Waters: Boulders and Waves in Compliance Development for Physician Practices

Elizabeth Skinner, RN, JD, Physician Practice Compliance Officer, TENET

presentation, evaluation survey

• Avoiding boulders: physician practice compliance challenges
• Riding the waves: implement best compliance practices
• Streamline compliance program development in established practices

602 – Patient Safety for Physician Practices

Julie Taitsman, MD, JD, Chief Medical Officer, Office of Inspector General, US Dept. of Health and Human Services
Christi Macrina Grimm, MPA, Special Assistant to the Principal Deputy Inspector General, Office of Inspector General, US Dept. of Health and Human Services

presentation, evaluation survey

• Patient safety
• Adverse events in hospitals
• Oversight policy and payment implications

2:15–3:15 pm

701 – Physician Recruitment Agreements: Managing Compliance

Tom Loughrey, CCS-P, Director of Compliance–Physician Practices, St Joseph Health System

presentation, evaluation survey

• Learn the five key compliance errors in the recruitment process
• Learn the key elements to include in a recruitment agreement with an income guarantee
• Develop a checklist of issues to cover that foster compliance and reduce risk

702 – Research Reform School / Clinical Research Compliance and Physician Responsibility

Karen Mottola, MA, CRCC, CPC, Clinical Research Compliance Officer, University of Utah
Kelly Willenberg, MBA, BSN, CHRC, President, Synergism, LLC

presentation, evaluation survey

• Billing compliance within the Medicare Guidelines and everyday operations
• Physician responsibility for maintaining clinical research compliance
• Impact on research with the Healthcare Reform and how it affects you