Presentations
"2013 Health Care Regulatory and Compliance Update," J.W. Marriott at LA Live, Los Angeles
03.07.13
This seminar discussed current developments in health care regulation and compliance for hospitals. Please view all of the recorded presentations on our Vimeo channel.
This year's topics included:
2012 Health Care Litigation in Review
Douglas Ross
- Round-up of hospital litigation trends
- Litigation challenging Health Care Reform and Obamacare
- Department of Justice (DOJ) challenge to Blue Shield's "most favored nations clause" with hospitals: What can hospitals do?
- California Attorney General (AG) investigation of hospital system's requiring payors to contract with all hospitals in order to get access to one hospital; Bundling multiple services for one (low) price
- Data breach litigation
- Federal Trade Commission (FTC) enforcement of hospital mergers and affiliations; What kinds of hospital cases does the FTC pursue?
What's Up with Hospital-Physician Transactions?
Dennis Diaz
- Establishing fair market value (FMV)
- Thorny Stark problems and creative fixes; Real-life examples
- Pay-for-performance update; Trending to reward Value—legal issues
- Transactions with Physician-Owned Distributors (PODs): How risky are they?
- "Auditing" your physician contracts—do's and don'ts
Stark Update
Bob Homchick
- Recent changes in the Stark regulations
- Government enforcement trends
- Voluntary disclosures to the government
- Evolving best practices for Stark compliance
Internal Compliance Investigations
Jeff Coopersmith
- The benefits and risks of conducting internal investigations in hospitals
- Who should direct and conduct internal investigations
- How to formulate an investigative plan
- Proper methods for conducting witness interviews
- Potential consequences of prosecution and methods to avoid or mitigate impacts of prosecution
- Protecting privileged materials created during the investigation
Update on Federal and State Audit Programs: RACs, MACs, MICs, ZPICs, and Medi-Cal
Kathy Drummy and Adam Romney
- Changes and recent developments in the Medicare RAC programs; Part A and Part B RACs; Rollout of the RAC program to the Medicare Part C and D programs
- Update on Medi-Cal audit programs; Rollout of the RAC program to Medi-Cal
- Overview and update of other federal audit programs: Medicare Administrative Contractors (MACs), Medicaid Integrity Contractors (MICs), Zone Program
- Integrity Contractors (ZPICs) and the new CMS anti-fraud command center in Baltimore
- Coordination of Look Backs and overpayment time periods
ACO Lessons Learned: MSSP and Commercial
Bob Homchick and Bob Schuchard
- Medicare SSP ACOs vs. Commercial ACOs: What are the typical requirements of each? What is different between the two forms of ACOs? The application process for MSSP
- ACO Challenges in formation: What are we seeing? What have been the hurdles? Tax exemption issues—operating in the Medicare and commercial and payor worlds
- ACO Fraud & Abuse (F&A) Waivers: What are the five F&A Waivers applicable to MSSP ACOs? What are the F&A risks?
- ACO operational issues: Attribution of beneficiaries; Physician exclusivity
The Long-Awaited Final HIPAA "Omnibus" Rule Has Been Published
Becky Williams
- New business associate obligations and contract provisions
- New breach notification requirements
- The good news and the bad news on changes to uses and disclosures
- Increased individual rights
- New enforcement requirements