Presented by:

Agenda — Monday, September 15, 2008

8:00 a.m.–9:00 a.m. Registration & Continental Breakfast

9:00 a.m.–10:20 a.m. Who’s Out There: Program Safeguard Contractors, State Auditors & the False Claims Act
Robert Liles, health care attorney, principal, Liles Parker, PLLC, Washington, D.C., and former National Health Care Fraud Coordinator at the U.S. Department of Justice.
There are a slew of agencies and contractors reviewing your claims with supercomputers and advanced mathematical formulas, from state Medicaid offices to CMS and its safeguard contractors, such as RACs and fiscal intermediaries. Their goal: ferret out false claims, make recoveries and prosecute as needed. Know your rights, and learn what steps to take right now to prepare and respond to an audit. Get proven guidance how to respond to contractor demand letters, steps to take to limit your exposure and tips to create a strong defense for your organization’s bottom line.
Take home tools: Audit checklist and preparedness guide.

10:20 a.m.–10:40 a.m. Refreshment Break

10:40 a.m.–Noon Documentation Risk Factors: Stark, Anti-Kickback and Troublesome Partnerships
Gabe Imperato, JD, Managing Partner, Broad and Cassel, Fort Lauderdale Your goal of maximizing revenue should include solid partnerships and referral relationships. But there also is a danger if inadequate attention is paid to the details of those relationships and the documentation used to support them. The risks are huge for those who are not aware of the nuance, detail and changes in the law. What is an appropriate gift? Are consulting agreements advisable or even acceptable? Get the answers to each of these questions and many, many more to help keep your enterprise profitable, growing and safe. Take-home tool: Sample policies to put to work at your organization.

Noon–1:00 p.m. Lunch (provided)

1:00 p.m.–2:00 p.m. How to Handle a Fraud Investigation & Other Unpleasantries
Gabe Imperato, JD, Managing Partner, Broad and Cassel, Fort Lauderdale What would you do if you get hit with the dreaded carrier audit letter or – even worse – get the OIG knocking at your door? It’s not uncommon for Gabe Imperato to have multiple open audits – federal and state – sitting on his desk. Gabe will walk you through the drill so you don’t get stung in this heightened era of MACs and RACs. Find out what proactive measures you need to take right now, when to do a shadow audit, the type of correction plan to put in place and which staff members should know about your audit. Take-home tool: Checklist for updating operational polices related external audit notices.

2:00 p.m.–3:00 p.m. How Carriers Investigate Claims & Act on Their Suspicions
Dr. Debra Patterson, Medical Director for TrailBlazer Health Enterprises in Dallas
Fiscal intermediaries and other third-party contractors have turned to an elixir of senior clinicians, advanced mathematical modeling and sophisticated computers to analyze years of records and ferret out tens of millions of dollars worth of false claims, abuse and mistakes. But how do they differentiate between innocent mistakes, small-time abuse and fraud? What does a physician auditor look for in a medical review? Get answers from the medical director of the largest FI in Texas along with tips and strategies to ensure that your claims are clean every time.

3:00 p.m.–3:20 p.m. Refreshment Break

3:20 p.m.–4:30 p.m. Compliance Plans: Rock-Solid & Iron-Clad… But Does it Work?
Sean Weiss, CCP-P, CPC, CPC-P, Vice President, DecisionHealth Professional Services
You may have an air-tight compliance plan. But what are you doing with it, especially with OIG crackdowns on ancillary services, RACs on the loose and clueless personnel running about? The best defense is a proactive approach that includes regular audits, benchmark measurements and updates. Explore how the savviest providers create and maintain an effective compliance program and determine where and when improvements are necessary.

4:30 p.m.–5:30 p.m. How to Conduct an Internal Audit, & What To Do With the Results
Sean Weiss, CCP-P, CPC, CPC-P, Vice President, DecisionHealth Professional Services
Even with the best compliance plan, you still need to identify potential areas of risk – long before the government does – and know how to handle potential fraud and abuse. Discover the tools you need to perform your own chart audits, deciphering what was done compared with what was documented, determining what qualifies as timing vs. context, how to confidently code the correct level of E/M service… and more. Then, get proven guidance on how to self-disclose and how much to reveal.
Take-home tool: Several audit tools you can use right away in your practice.

5:30 p.m. Adjourn