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2002 Compliance Institute Presentations
12:00 5:00 PM Concurrent Sessions
I. Long Term Care Compliance
Chairs: Bill Altman and Eileen
Coggins, Vice President of Compliance,
Genesis Health Ventures
James Pfeiffer and Brian Zoeller,
Kindred
Healthcare, Inc.
HIPAA Case Study: Long Term Care (LTC) Industry
Andrew Penn, Office of
Inspector General
M.T. Connoly, Department
of Justice
Irene Fleishner, Vice
President of Clinical Operations, Genesis Health Ventures, Philadelphia,
PA
Ronald Orth, RN, Director
of Utilization Compliance, Kindred Healthcare, Inc.
Patricia J. Boyer NHA,
RN, BDO / Heritage Healthcare Group
Compliance
Issues under Medicare Prospective Payment for Nursing Facilities
II. Academic & Research Compliance
Judy Argon, Vice President
of Research Administration, Childrens Hospital of Philadelphia, Philadelphia,
PA
John Allen, Asst. VP
for Scientific Affairs, State Univ. of NY, Brooklyn, NY
F. Lisa Murtha, JD, Chief
Audit & Compliance Officer, Childrens Hospital of Philadelphia, Philadelphia,PA
HIPAA
Privacy and the Academic Medical Center
Chris Jedrey, Attorney,
McDermott, Will & Emery, Boston, MA
Academic & Research Compliance
HIPAA:
Open Research Issues
III. Payors/Managed Care Compliance
Chair: Vickie McCormick
HIPAA for Payor Organizations
Michelle Huntley, UnitedHealth
Group, Minnetonka, MN
Wendy Krasner, Attorney,
McDermott, Will & Emery, Washington, DC
Key
Issues For Health Plans Under HIPAA Privacy Regulations
Elizabeth Moran, Attorney,
Halleland, Lewis, Nilan, Sipkins & Johnson
Vickie McCormick, Halleland
& Lewis, Minnetonka, MN
Payor
Relationships with the Pharmaceutical Industry
Sharon Hayman, Newark,
NJ
Mike Treash, Ernst &
Young
War Stories and Deep Thoughts
Robert Freeman, BCBS
of Massachusetts, Boston, MA
Emil Moschella, BCBS
of New Jersey
Compliance Programs for Payor Organizations
IV. Health Care Privacy Officer
Compliance Panel Discussion on Privacy
The Health Care Industrys
New Trademark
Anthony Boswell Esq., Ethics,
Privacy, Compliance Officer and Corporate Counsel, Laidlaw, Inc.
Peter Adler, Attorney,
Foley & Lardner, Washington, DC
Alyse Hutchinson, Esq.,
Assistant
Privacy Officer, American Medical Response, Inc.
Chuck Steen, Privacy
& Data Security Officer, Catholic Healthcare West
Mark Meaney, PhD, Executive
Director, Institute for Clinical & Corporate Ethics
Chuck
Steen: The Role of the Privacy Officer
Mark
Meaney: Integrating Privacy into Organizational Culture
V. Integrated Health Care Systems Compliance
Moderator: Michael
Hemsley, CHC, VP/Corporate Compliance & Legal Services, Catholic
Health East, Newtown Square, PA
Alan Yuspeh, Senior Vice
President for Ethics, Compliance and Corporate Responsibility
Kathi Whalen, Assistant
Vice President, Ethics and Compliance Program Development
Bill Middleton, Case
Manager
Jim Finnegan, Manager,
Ethics and Compliance Program Assessment
Sara Martin-Michels, CHC,
Senior
Compliance Analyst
Holly Winn, Training
Analyst
Exec
Summary
Chicago
2002 Case Study
CPR-Corrective
Action Plan
CPR-Report
of Findings
EC
Workplan2002
Facility
Ethics and Compliance Program Review
Integrated
Health Care Systems Compliance
Revised
Licensure and Certification (Divider)
Memo:
Compliance Policies and Procedures
Professional
Courtesy Discount Checklist
Elements of a compliance
program, including setting standards, creating awareness, measuring effectiveness,
allowing for exceptions to be reported and establishing an organizational
structure to support the other elements
How we have implemented
a program across an organization comprised of hundreds of hospitals, ambulatory
surgery centers and physician practices
VI. The Compliance Officer Forum
Compliance Document Workshop
Shawn DeGroot, CHC, Compliance
Director, VA Medical Center and Regional Office Center, Sioux Falls, SD
Christine Boras, CFE,
CHX, MBA, CCO, United Health Services, Inc., Binghamton, NY
Kathy Merlo, St. Louis
University, St. Louis, M
Greg Warner, Director
of Compliance, Mayo Clinic, Rochester, MN
Agenda
Power
Point "RISK2002"
Compliance
Audit Review Plan
Audit
Review Schedule
Risk
Matrix
Laboratory Audit and Compliance Plans
Reporting
and Responding to Allegations of Non-Compliance
Compliance
Acknowledgment Receipt Form
Compliance
Communications Log
Compliance
Communications Report
Compliance
Risk Assessment Management Interviews
Compliance
& Business Integrity
Risk
Assessment Tracking
8:30 9:15 AM
General Session Bioterrorism and Health Care Readiness
Alice Gosfield, Attorney,
Alice Gosfield and Associates, PC, Philadelphia, PA
The
Quality/ Compliance Nexus: Doing Well by Doing Right
9:30 10:30 AM
General Session Health Care Fraud & Abuse Issues: The Medias Perspective
Peter Klein, Producer/60
Minutes, New York, NY
Bruce Japsen, Chicago
Tribune, Chicago, IL
Mark Taylor, Modern Healthcare,
Chicago, IL
Lisa Rockelli, BNA Healthcare,
Washington, DC
Craig Webb, Editor, AHA
News, American Hospital Association, Washington, DC
Moderator: Lisa Murtha,
CHOP,
Philadelphia, PA
11:00 12:15 PM Concurrent Sessions I
101
Practical Tools for Auditing & Monitoring
Sheryl Vacca, CHC, Director,
National Health Care Compliance Practice, Deloitte & Touche, Los Angeles,
CA
Vickie McCormick, Halleland
& Lewis, Minnetonka, MN
Complaint
& Appeal Auditing
Credentialing
File Review
Credentialing
SAMPLE
Employer
Group Files Audit
Formal
Complaint Audit Tool
Generic
Audit Tool
Complaint
& Appeal Audit
Member
Handbook Annual Review
Payor
Controls Review & Testing Matrix
Practical
Tools for Auditing & Monitoring
Provider
Directory Annual Review
Practical application of
Hands on Tools
Methodology and Sampling
Techniques
Disclosure Strategies
102
Compliance Effectiveness for 2002 and Beyond: Taking Compliance Effectiveness
to the Next Level
David Orbuch, Corporate
Compliance Officer, Allina Health System, Minnetonka, MN
William Altman, Vice
President of Compliance and Government Affairs, Kindred Healthcare, Louisville,
KY
Taking Compliance Effectiveness to the Next Level
Michael Hemsley, CHC, VP/Corporate
Compliance & Legal Services, Catholic Health East, Newtown Square,
PA
Update on latest compliance
effectiveness initiatives
Innovative approaches
to evaluating effectiveness
Using effectiveness measures
to demonstrate value
Charting an effective
approach for the future
103
Coding for Attorneys and Compliance Professionals
Georgette Gustin, Director,
PricewaterhouseCoopers, Indianapolis, IN
Susan Postal, VP of Health
Information Management Services Government Programs, HCA, Nashville,
TN
Coding
for Attorneys and Compliance Professionals
Provide an overview of
common coding classifications currently used in the inpatient, ambulatory
and physician settings
Describe commonly used
nomenclature and terminology
Components of successful
coding/health information
Management compliance
program; e.g., organizational structure, creating awareness, setting standards,
monitoring performance, identifying exceptions
104
What CCOs are Doing with Their On-line Training
Dan Roach, VP/Corporate
Compliance Officer, Catholic Healthcare West, San Francisco, CA
Suzie Draper, Compliance
Administrator, Intermountain Health Care, Salt Lake City, UT
Use of on-line training
programs
Developing on-line education
Beware the unanticipated
cost
On-line training resources
12:30 2:15 PM
Lunch Presentation Quality and Compliance
Mindy Hatton, VP & Chief Washington
Counsel, Washington, DC
The
New Proposed Changes to the Privacy Regulations
2:15- 3:30 PM Concurrent Sessions II
201
Security and Transactions and Code Sets, the Technical Side of HIPAA Compliance
Victor Blanchard, Arthur
Andersen, Baltimore, MD
Ed Shay, Attorney, Post
& Schell, Philadelphia, PA
HIPAA
Update: Everything But Privacy
HHS
Proposes Changes That Protect Privacy, Access to Care
Standards
for Privacy of Individually Identifiable Health Information Proposed
Rule Modification
Most health care enterprises have moved beyond initial awareness of compliance with the transaction/code set and security requirements of HIPAA. This session will build from that knowledge base and describe current developments in transactions, code sets and security. It will cover current implementation challenges such as testing/certification requirements for extensions under the recently enacted compliance date extension legislation strategies for submitting a credible application. The session will examine new challenges posed by soon-to-be issued final security rules for those who have already done their gap assessments based on the proposed rules.
202
Business Associates What Should You be Doing Now?
Jody Ann Noon, Partner,
Deloitte & Touche, Portland, OR
Linda Malek, Attorney,
Moses & Singer, New York, NY
Business
Associates: What Should You Be Doing?
Overview of the HIPAA Business
Associate Requirements
Practical approaches to
identify business associates
A Step-by-Step Guide to
implement the HIPAA Business Associate Requirements
Identifying who your business
associates are
Required elements of a
business associate agreement
Considerations for drafting
a business associate agreement
203
Compliance Officer Personal Liability and Insurance Coverage Issues
Elizabeth Carder, Attorney,
Reed Smith, Washington, DC
Compliance
Officer Personal Liability Issues
Does D&O coverage really
protect the compliance professional?
Does the compliance professional
have personal exposure?
What should the compliance
professional do to mitigate potential exposures?
Review of HCCA Compliance
Professional Ethical Obligations Statement for guidance.
204
Updates on the False Claims Act
Margaret Hutchinson, Assistant
US Attorney, US Attorneys Office, Philadelphia, PA
2002 focus areas of the
Department of Justice
Understand what to do
to avoid False Claims Act exposure
Proactive compliance measures
every healthcare organization should consider
Handouts provided in Hard Copy only
3:45 5:00 PM Concurrent Sessions III
301
Advanced Investigations, Privileges and Disclosure
Doug Lankler, Pfizer,
New York, NY
Mike Kendall, Attorney,
McDermott Will & Emery, Boston, MA
Advanced
Investigations, Privileges and Disclosures
Responding
to Enforcement Initiatives
Audit
Results
How to conduct an Effective
and Ethical Internal Investigation in Defense of the Government Investigation
How to conduct a vigorous
defense without running a follow-up of ethical rules (of the government)
How to understand/anticipate
government strategies
Strategic and Tactical
concerns where defending a provider undergoing Government Scrutiny
302
Stark 2002: A Detailed Overview of the Law
Gadi Weinreich, Attorney,
Shaw Pittman, Washington, DC
Application and scope of
the Stark law and its exceptions: reality vs myth
Principal regulatory developments
Current government enforcement
initiatives and compliance solutions
303
Research Compliance and Human Subject Research
Lisa Murtha, CHOP, Philadelphia,
PA
Kendra Dimond, Attorney, Epstein
Becker & Green, Washington, DC
Conflicts
of Interest - Individual and Organizational
Conflict
Of Interest Issues Resource Material For Additional Information
Overview of Federal Enforcement Initiatives
in Research
Overview of Key Laws and Regulations
affecting research
Overview of Administrative and Human
Subject Protection Requirements
Compliance Recommendations for Clinical
Research and Trends
304
Governance: The Balance of Power
Marti Arvin, CHC, Compliance
Officer, University of Pittsburgh Physicians, Pittsburgh, PA
Dr. Thomas Clay, Compliance
Officer, East Carolina University School of Medicine, Greenville, NC
How does your organizational
chart effect decision making and access to resources
Your leverage for management
and physician buy-in
7:00 Enron and
Andersen: Heed the Questions and Warnings They Raise for Your Own Company
Joseph Murphy,President, Compliance
Systems Legal Group, Haddonfield, NJ
Howard Young, Arent Fox, Washington,
DC
Greg Warner, Dir. of Complaicne,
Mayo Clinic, Rochester, MN
Sheryl Vacca, CHC, Dir., National
Health Care Complaicne Practice, Deliotte & Touche, Los Angeles, CA
Moderator: Brent Saunders, Partner,
PricewaterhouseCoopers, Washington, DC
Heed
the Questions and Warnings
Report
1
Report
2
Report
3
Report
4
8:30 9:15 AM
General Session Bioterrorisms Impact on Health Care Operations
Bob Arnot, MD, NBC News,
New York, NY
9:15 10:15 AM
Regulatory Panel Hot Topics and Current Events
Moderator: Brent
Saunders, Partner, PricewaterhouseCoopers, Washington, DC
Lewis Morris, Asst. Inspector
General for Legal Affairs, Office of the Inspector General in the US Dept.
of HHS, Washington, DC
James Sheehan, Asst.
US Attorney and Chief, Civil Division, United States Attorneys Office,
Philadelphia, PA
Phil Dunne, Chief Executive
Officer, Texas Medical Foundation, Austin, Texas
Payment
Error Prevention Program
Comparison
of Sixth Scope of Work to Seventh Scope of Work
10:45 12:00 PM Concurrent Sessions IV
401
Privacy Assessments: Beginning the Process
Chuck Self, Baptist Health
Systems, Birmingham, AL
Debbie Troklus, CHC, Manager,
PricewaterhouseCoopers, Louisville, KY
Privacy
Assessment: Beginning the Process
Common
Privacy Projects
Amendment
of PHI 164.526 Checklist for compliance with regulation
Seven steps to beginning
the process
Gap analysis vs. project
approach
Common privacy projects
Structuring project teams
402
Sampling Techniques for Auditing and Monitoring
Sandy Piersol, Senior
Manager, Deloitte & Touche, Philadelphia, PA
Sampling
Techniques for Auditing and Monitoring
Darrell Contreras, Manager,
Ernst & Young, Phoenix, AZ
Sampling
Techniques for Auditing and Monitoring
Understand how to sample
for baseline assessments, annual auditing and CIA auditing as well
Learn about probe samples-the
value, the risk
What is extrapolation-how
does it hurt and how does it help
Random sampling and degrees
of precision
Do you need to test every
provider?
What is the 80/20 rule
and how does it work?
403
Ethics and the Compliance Professional
Jeffrey Oak, Compliance
& Business Integrity, Veterans Administration, Washington, DC
Mark Meaney, Executive
Director, Bioethicist, Institute for Clinical and Corporate Ethics, Liberty,
MO
Thinking
Like a Compliance Professional
Case
Study: A Duty to Resist?
Conflicts of Interest for
Compliance Professionals
Responsibilities to Diverse
Stockholders
Political Capital: Spending
It, Saving It and Sharing It
404
Current Events and Hot Topics in HIPAA
Moderator: Ryan Meade,
Attorney,
Katten Muchin Zavis, Chicago, IL
Leslie Berkeyheiser, The
Clayton Group, Glen Mills, PA
Ted Sanford, MD, University
of MI Health Systems, Ann Arbor, MI
Sue Prophet, CHC, RHIA,
CCS, Director of Coding, Policy & Compliance, AHIMA, Chicago, IL
Recent legislation
State law preemption &
state privacy initiatives
Trends in implementation
in light of regulatory ambiguities
12:00 1:30 PM
Lunch Presentation - Update on HCCA Coalition to Study Compliance Program
Effectiveness
L. Stephan Vincze, CHC, Ethics
& Compliance Officer, TAP Pharmaceutical Products, Inc., Lake Forrest,
IL
1:45 3:00 PM Concurrent Sessions V
501
Physician Compliance Training
Phoebe Moore, BA, CPC, CPC-H,
Relationship
Manager, HP3 Healthcare Concepts, Bethlehem, PA
Physician
Compliance Training
Joette Derricks, CHC, CEO,
Healthcare
Management Solution Inc., Camp Hill, PA
Physician
Compliance Training
What should a physician
practice compliance program look like?
Styles of training including
web-based options, videos, live training, using sample records to train
How often should training
take place and what areas should be covered?
Use of external experts
for training
502
Managed Care Compliance Risks
V. Jones, Attorney, Foley
& Lardner, San Francisco, CA
Vickie McCormick, Halleland
& Lewis, Minnetonka, MN
Managed
Care Compliance Risks
Managed care regulatory
compliance issues
Monitoring and auditing
in managed care
Coordinating compliance
with providers
503
Privacy Primer The Overview You Have Been Waiting For!
Amanda Yoh, Compliance
Manager, Laidlaw, Inc., Arlington, TX
HIPAA:
The Overview You Have Been Waiting For!
Lisa Clark, Attorney,
Duane Morris & Hecksher, Philadelphia, PA
HIPAA
Privacy Primer:Covered Entities, Business Associates and other HIPAA Designations
A brief overview of the
HIPAA privacy regulations
Most recent HHS guidance
on how to interpret complex and confusing areas under the regulations
Focus on "hot" issues,
including how to draft business associates agreements, consents and notices,
how to identify business associates, hospital/medical staff disclosure
issues, and implementation best practices
504
Conflicts of Interest Individual and Organizational
Monte Dube, Attorney, McDermott
Will & Emery, Chicago, IL
Implementing
a Clinical Research Compliance Program.
How to manage and implement a conflicts
program
Designing a conflicts policy
Understanding research and clinical
conflicts of interest
Monitoring conflicts of interest
3:15 4:30 PM Concurrent Sessions VI
601
Quality Issues and Compliance
Sheryl Vacca, CHC, Director,
National Health Care Compliance Practice, Deloitte & Touche, Los Angeles,
CA
Kristin Jenkins, Compliance
& Quality Officer, JPS Health Network, Fort Worth, TX
The Governments Interest
in Quality from a Compliance Perspective
The
Ethical Framework for the Compliance Effort in VHA
Overlaps in Compliance
and Quality Reviews and Functions The OIG, JCAHO and Beyond
Selling the Idea of Combining
the Compliance and Quality Functions to your CEO
602
To De-Identify or Not to De-Identify. That is the Question?
Kent Giles, PricewaterhouseCoopers,
Atlanta, GA
To
Identify or Not to Identify, that is the Question
What are identifiers and
what does HIPAA require you to do about them?
Understanding what institutions
should be doing about Identifiers today
Policies and procedures
necessary for HIPAA compliance
603
Integrating HIPAA Into Your Compliance Program
Carole Klove, Partner,
Deloitte & Touche, Los Angeles, CA
Implementing
HIPAA into a Compliance Program
Ken Fody, Esq., Independence
Blue Cross, Philadelphia, PA
Combining HIPAA Readiness
Into Compliance Audits
Integrating HIPAA Issues
into Compliance Training
604
HIPAA Readiness Survey/Tools for Self Assessment
John Steiner, Director
of Corporate Compliance, Cleveland Clinic Foundation, Cleveland, OH
Kristin Johnson, KPMG,
New York, NY
State of HIPAA Compliance
Findings of the HCCA HIPAA
Benchmarking Study
HCCA HIPAA Readiness Survey
Survey Results
Implementation, Process:
Where is Your Program?
I. Compliance 101
Debbie Troklus, CHC, Manager,
PricewaterhouseCoopers, Louisville, KY
John Knapp, Partner,
Cozen & O'Connor, Philadelphia, PA
Compliance
101 Handout
New or aspiring health care compliance professionals face many challenges as they make their way into a new position or career. This popular session has been offered a round the country and has provided instruction on the basics of health care compliance to compliance professionals from all healthcare settings. Topics include: Defining compliance, compliance necessity, the seven essential elements of a compliance program and compliance program start-up.
II. Compliance 202 - Graduate Level
Sheryl Vacca, CHC, Director,
National Health Care Compliance Practice, Deloitte & Touche, Los Angeles,
CA
Allison Maney, CHC, CPA,
Compliance
Officer, Lovelace Health System, Albuquerque, NM
Compliance
Program Management: Operations and Effectiveness
The duties of a compliance professional do not end when the compliance program is up and running. Auditing, monitoring and constant follow-up are a must and how do you know if your program is actually effective? How does a program adjust to shifting trends in enforcement and new regulations? This session answers these questions and provides the opportunity for experienced compliance professionals to learn from each others shared challenges and concerns.
III. HIPAA Document Workshop
Kristin Jenkins, District
Compliance Officer, JPS Health Network, Fort Worth, TX
Lisa L. Dahm, Attorney,
MedSafe, Houston, TX
Robert Lower, Partner,
Alston & Bird, Atlanta, GA
Brian Gradle, Partner,
Epstein Becker & Green, Washington, DC
Notice
of Privacy Practices Template
Security
Assessment Template
Review and discuss project
and workgroup documentation, board and executive reporting formats and
model consents, authorizations and other documents and changes necessary
to your systems policies and procedures for adherence to HIPAA regulations.
NOTE: Review will not be
comprehensive (due to time constraints), but information can be used to
develop comprehensive plans for your organization.