Last Year's Agenda

July 27th, 2020

8:50AM – 9:00AM EDT

Welcome Remarks

Rafael Gonzalez, Esq., President,  

Medicare & Medicaid Compliance  


9:00AM – 9:45AM EDT

CMS Notice of Proposed Rules Part 1: A Historical Review of Mandatory Reporting Civil Money Penalties

9:45AM-10:00AM EDT
Session Transition

10:00AM – 10:45AM EDT

CMS Notice of Proposed Rules Part 2: An Analysis of the Mandatory Reporting Proposed Civil Money Penalty Regulations

  • Evaluate civil money penalty bases and scope; assess its potential impact, especially as they relate to the conditional payment resolution process 
  • Analyze civil money penalties imposition and amounts that could be handed by CMS, especially in connection with the resolution of conditional payments 
  • Proven good faith effort to reduce or extinguish the possibility of receiving civil money penalties 

 

LaVonya Chapman, RN, Esq.,  Associate General Counsel, Settlement Solutions 

UnitedHealth/Optum Workers Compensation and Auto No-Fault  

 

Robert Finley, Esq., Partner 

Hinshaw Law 

10:45AM-11:00AM EDT
Session Transition

11:00AM- 11:40AM EDT

Regulation and Legislation Update: Medicare Secondary Payer Conditional Payments Case Law Update

  • Analyze which organizations and individuals the U.S Federal Government is suing for reimbursement of conditional payments  
  • Identify which entities Medicare Advantage Plans and their assignees are suing for reimbursement of conditional payments  
  • Review of the hottest cases relative to resolution of conditional payment and how the case law is evolving, providing attendees with trends and patterns that allow for best practices 

 

Heather Hatch, Partner 

The Chartwell Law Offices, LLP  

 

Rachel LaMontagne, Esq., Partner 

Shutts & Bowen 

11:40AM-11:55AM EDT
Session Transition

11:55AM – 12:40PM EDT

Regulation and Legislation Update: Medicare Advantage and Part D Conditional Payment Best Practices

  • Outline current available methodologies to determine a beneficiary’s Medicare Advantage and Part D enrollment status 
  • Identify key jurisdictions in which Medicare Advantage and Part D have the same double damages recovery rights as traditional Medicare 
  • Provide Best Practices for payors to implement to avoid lawsuits and claims from Medicare Advantage and Part D for double damages 

 

Heather Schwartz Sanderson, Esq., Chief Legal Officer,  

Franco Signor LLC 

12:40PM- 1:10PM EDT
Lunch

1:10PM-1:50PM EDT

Conditional Payment: When Conditional Payments Go Wrong: Dealing with the U.S. Department of Treasury

  • Case Study: Dissect a recent account where the U.S. Department of Treasury offset an organization and another one in which a beneficiary’s monthly benefits were reduced 
  • An overview from lawyers representing applicable plans/payers and beneficiaries dealing with the U.S. Treasury that were offset unreimbursed past due amounts 
  • Strategies to avoid conflict with and offsets from the U.S Department of Treasury 

 

Vanessa Lipsky, Partner/Section Lead Medicare Compliance Department 

Eraclides Gelman Attorneys at Law  

 

 

1:50PM-2:05PM EDT
Session Transition

2:05PM – 2:45PM EDT

Conditional Payment: When Conditional Payments Go Wrong: Dealing with the U.S. Department of Justice

  • Hear what happens to lawyers and law firms representing Medicare beneficiaries who fail to reimburse conditional payments after the case settles  
  • Examine if the same thing could happen to employers, carriers, and third party administrators 
  • Identify when payers are responsible for reimbursement of conditional payment and how to avoid conflict with U.S. Department of Justice 

 

Jason D. Lazarus, J.D., LL.M., MSCC, CSSC, Chief Executive Officer 

Synergy Settlement Services 

2:45PM-3:00PM EDT
Session Transition

3:00PM – 3:40PM EDT

Conditional Payment from Conception to Completion: Verification of Claimant’s Medicare Beneficiary Status

  • Obtain the correct documentation from the beneficiary to verify current Medicare status 
  • Validate with Medicare Advantage Plans and prescription drug plans to confirm status 
  • Utilize the mandatory reporting process to verify current Medicare beneficiary status 

 

Michelle Allan, Partner 

Gordon Rees Scully  Mansukhani  

3:40PM-3:55PM EDT
Session Transition

3:55PM – 4:35PM EDT

Conditional Payment from Conception to Completion: Verification of Data Submitted Through Mandatory Insurer Reporting

  • Confirm date of accident/incident, ORM acceptance and termination dates, and TPOC date and amount are correctly reported  
  • Verify the injuries related to the claim or that have been released/settled have been reported accurately  
  • Certify ICD-10 codes that have been reported are accurate; and if they are not, what to do about it before you dispute or appeal CRC and BCRC’s request for reimbursement  

 

Frank Fairchok,  

Independent Consultant 

 

Suzanne Jordan, SCHIP Compliance Manager  

Broadspire 

4:35PM-4:45PM EDT

Chairperson Closing Remarks

Rafael Gonzalez, Esq., Former President, Settlement Solutions, Workers Compensation and Auto No-

Rafael Gonzalez, Esq., President,  

Medicare & Medicaid Compliance 

 

July 28th, 2020

8:50AM – 9:00AM EDT

Opening Remarks & Review of Day 1

Rafael Gonzalez, Esq., President,  

Medicare & Medicaid Compliance

 

9:00AM-9:40AM EDT

Conditional Payment from Conception to Completion: Verification of Government’s Request Through the CMS Portals

Conditional Payment from Conception to Completion 

 

Verification of Government’s Request Through the CMS Portals  

 

  • Confirm information on portal indicates all correct information on beneficiary and claim 
  • Affirm that portal amount matches the written request for reimbursement by CMS; and if not find and explain inconsistencies between the two 
  • Validate the correct amount owed as a basis for your request for disputes and further appeals, if necessary 

 

Rose Arellano, Independent Consultant 

Medicare Secondary Subject Matter Expert 

 

LaVonya  Chapman, RN, Esq.,  Associate General Counsel, Settlement Solutions 

UnitedHealth/Optum Workers Compensation and Auto No-Fault  

9:40AM-9:55AM EDT
Session Transition

9:55AM – 10:35AM EDT

Conditional Payment from Conception to Completion: Analyzing CMS’ Request for Reimbursement of Medicare Conditional Payments

  • Analyze CMS request for reimbursement from the CRC to confirm payments are listed and claimed correctly 
  • Assess CMS request for reimbursement from the BCRC to verify payments are itemized and requested accurately  
  • Determine which conditional payments are and are not related to the claim; identify discrepancies and formulate explanation and arguments for same 

 

Monica Williams, Medicare Compliance Manager 

Innovative Claims Strategies  

 

Rose Arellano, Independent Consultant 

Medicare Secondary Subject Matter Expert 

10:35AM-10:50AM EDT
Session Transition

10:50AM – 11:30AM EDT

Conditional Payment from Conception to Completion- Continued: Disputing Medicare Conditional Payments

  • An explanation and discussion of the process to dispute conditional payments with the CRC and the BCRC 
  • Identify which evidence you must, may, or can provide to the CRC and BCRC to support your arguments 
  • Evaluate which argument and strategies during dispute process generate the best success rates 

 

Rose Arellano, Independent Consultant 

Medicare Secondary Subject Matter Expert 

 

John V. Cattie, Jr., Founding Member 

Cattie, P.L.L.C. 

11:30AM-11:45AM EDT
Session Transition

11:45AM – 12:25PM EDT

Conditional Payment from Conception to Completion: Requesting Redetermination of Medicare’s Demand for Reimbursement of Conditional Payments

  • Strategies to improve consistency between arguments made throughout dispute process and mandatory reporting data submitted to CMS in light of proposed Civil Money Penalties  
  • Analyze and critique actual Request for Determination that have previously been submitted to identify success, failure, missed opportunities, and inconsistencies 
  • Examine and further explore which strategies were successful, which arguments won or lost, and the feedback provided by the CRC and BCRC to identify best practices  

 

Rose Arellano

Medicare Secondary Subject Matter Expert 

 

Robert Finley, Esq., Partner 

Hinshaw Law 

12:25PM-12:55PM EDT
Lunch

12:55PM-1:35PM EDT

Conditional Payment from Conception to Completion: Requesting Reconsideration of Medicare’s Demand for Reimbursement of Conditional Payments

  • Avoid using the same arguments in reconsideration if they were unsuccessful in redetermination. Strategies to create new arguments using the same evidence 
  • Review an analysis of actual Request for Reconsiderations filed with the CRC and BCRC to examine success and failure and identify best practices  
  • Identify patterns and trends from the various Qualified Independent Contractors deciding the Request for Reconsideration. Analyze what works and what doesn’t 

 

Rose Arellano

Medicare Secondary Subject Matter Expert 

 

Heather Hatch, Partner 

The Chartwell Law Offices, LLP  

 

1:35PM – 1:50PM EDT
Session Transition

1:50PM – 2:30PM EDT

Conditional Payment from Conception to Completion: Preparing for and Successfully Handling the Hearing Before the Administrative Law Judge

  • Identify which evidence and exhibits will be critical to present to the ALJ to win your argument 
  • Introduce witnesses such as the adjuster, claimant, and doctor, to your case to increase validity of your argument and chances of winning 
  • Prepare all arguments based on facts of the case, limited to the items that you have appealed, relying on evidence submitted through Request for Reconsideration level 

 

Rose Arellano, Independent Consultant 

Medicare Secondary Subject Matter Expert 

 

Michelle Allan, Partner 

Gordon Rees Scully Mansukhani  

2:30PM-2:45PM
Session Transition

2:45PM – 3:25PM EDT

Conditional Payment from Conception to Completion Post ALJ Hearing Request for Review by the Medicare Appeals Council and Beyond

  • Review and analyze the ALJ decision to evaluate if it is the correct decision based on the evidence and law 
  • Identify errors in the ALJ decision with an eye towards requesting review by the Medicare Appeals Council- Examine what you should be looking for and best arguments to win or remand 
  • Prepare to request a review by U.S. District Court, if response from Medicare Appeals Counsel is deemed incorrect based on evidence and law 
  • Examine if requesting a review at the U.S. District Court is the best option and whether appealing at the Medicare Appeals Council is the best decision 

 

Rose Arellano, Independent Consultant 

Medicare Secondary Subject Matter Expert 

 

Vanessa Lipsky, Partner/Section Lead Medicare Compliance Department 

Eraclides Gelman Attorneys at Law 

3:25PM-3:35PM EDT

Closing Remarks

 

Rafael Gonzalez, Esq., FormerPresident, Settlement Solutions, Workers Compensation and Auto No-Fault  

Independent Consultant