Rise

Welcome and Chairperson’s Opening Remarks

Angela Lloyd, Associate Compliance Officer
Jefferson Health Plans

Keynote Address: Trends in False Claims Act Litigation, OIG Audits, and Other Risk Areas

Gregory Demske, Partner
Goodwin Procter LLP
Former Chief Counsel to the Inspector General
HHS OIG

CMS Latest Rule Changes: Key Provisions Impacting Your Compliance Program

Get details about the massive changes in the latest codified rules affecting: 

• Utilization Management 
• Marketing 
• Star Ratings Program 
• Health Equity 
• Access to behavioral health 
• Risk adjustment

Ana Handshuh, CHC, Principal
CAT5 Strategies

Colleen Gianatasio, Director, Clinical Documentation Integrity and Coding Compliance
Capital District Physician's Health Plan

Get a Handle on New Utilization Management Requirements

Get an overview and compliance tips for CMS’ new utilization management rules, including requirements for: 

• Prior authorization  
• Coordination of care 
• The creation of a Utilization Management Committee 

Jennifer Del Villar, CHC, Director of Government Programs Compliance / Medicare Compliance Officer
Cambia Health Solutions, Inc.

Annie Shieh, Sr. Director of Compliance, California Compliance Officer
Bright Health Group

Gail Blacklock, CHC, Compliance Officer
Astiva Health

CMS Program Audit Prep: Best Practices for Surviving and Thriving

• Hear lessons learned from plans that have recently been audited 
• Get tips for creating and testing your universes 
• Learn what to expect during the corrective action phase 

Moderator:

Tracy Jones, Interim Chief Compliance Officer
SummaCare

Angela Keenan, Compliance Officer
Network Health 

Dalissa Kelly, Director, Regulatory Pharmacy & Operations
Neighborhood Health Plan of Rhode Island

Vendor Compliance Oversight: How to Monitor and Lower Your Risk

• Review best practices for contracting and delegation agreements 
• Learn about the reports you should get from your vendors and how to analyze them 
• Create and implement service level metrics to avoid costly mistakes 
• Get tips for training internal staff and vendors to improve precision 

Jordan Flynn, Chief Compliance Officer
ATRIO Health Plans

Complying with New CMS Behavioral Health Access Requirements

• Understand new network adequacy requirements aimed at increasing access to behavioral health providers 
• Ensure your organization is following the rules for prior authorization, care coordination programs, and more 
• Explore risk areas and enforcement trends targeting behavioral health parity 

Tricia Beckmann, Principal
Faegre Drinker

Tina Korty, Vice President of Legal, Compliance, and Regulatory
Indiana University Health Plans

Closing Remarks

Angela Lloyd, Associate Compliance Officer
Jefferson Health Plans

Chairperson’s Opening Remarks and Day One Takeaways

Angela Lloyd, Associate Compliance Officer
Jefferson Health Plans

The RADV Audit Is Back: Here’s What You Need to Know

• Get ready for Risk Adjustment Data Validation (RADV) audits, which CMS has restarted after a hiatus during COVID  
• Understand the importance of two-way reviews to find coding deletes 
• Learn about the 12 high-risk diagnosis codes on the OIG watch list 

Jeannine Bumford, Director of Coding Operations
Southwestern Health Resources

Laura Sheriff, Vice President, Risk Adjustment
Southwestern Health Resources

The Value of a Mock CMS Program Audit

• Hear about real-life experiences with a mock audit 
• Get step-by-step details on how plans have conducted the mock audits 
• Learn about identifying issues and correcting them before you face a real CMS audit 

Angela Lloyd, Associate Compliance Officer
Jefferson Health Plans

Carissa Lingenhag, Supervisor of Compliance 
Network Health 

Compliance Program Effectiveness: Build a Tracer That Will Knock Their Socks Off

• Understand how tracers are used during a CMS audit to show specifically how your compliance program resolved issues 
• Explore the CMS requirements for tracers 
• Get tips for creating tracers that will shine a light on the strengths of your compliance program and impress CMS auditors 

Tracy Jones, Interim Chief Compliance Officer
SummaCare

Angela Keenan, Compliance Officer
Network Health

New DOJ Guidance on Messaging Apps

• Learn about the Department of Justice’s (DOJ) new efforts to make sure workplace communications via messaging apps like Slack and Teams can be preserved and accessed 
• Evaluate your policies for “bring your own device” (BYOD) and the permissible use of other mobile devices and messaging apps 
• Understand the consequences of not having the appropriate policies and procedures in place regarding the use of these communication devices 

Tina C. Tolliver, Executive Ethics, Compliance, Risk & Privacy Advisor
TCT Consulting

Nakis Urfi, Former Compliance Officer & ESG Leader
Babylon Health

Lessons Learned from the CMS Audit and Enforcement Report

• Analyze recent violations that resulted in enforcement actions, including large civil money penalties, which are disclosed in the annual CMS Program Audit and Enforcement Report
• Consider where your weaknesses might be and how to strengthen those areas 
• Get tips on how to avoid common violations 

Mary A. Inman, Partner
Constantine Cannon

Julie Davis, Compliance Senior Manager
Honest Medical Group

Elevating the Compliance Department’s Worth to Leadership

• Learn how to demonstrate the compliance function’s value in this age of inflation and inevitable cuts 
• Get tips on how to communicate with the board and other leaders  
• Understand the type of information and level of detail board members want about compliance efforts 

Sarah Peix, Compliance and Privacy Officer
ChenMed

Jordan Muhlestein, Compliance and Ethics Director
Intermountain Healthcare

Closing Remarks

Angela Lloyd, Associate Compliance Officer
Jefferson Health Plans