Risk Areas Planned for Review and Regulatory Changes - New Challenges With Respect to Government Audits and Investigations in Health Care

Why Should You Attend:

With healthcare reform progressing from concept to reality, the efforts to recoup overpayments and identify fraud and abuse have intensified, and there are more agencies than ever looking for these cases. Most organizations are using their resources to get compliant with the many emerging regulations and changes, such as ICD-10 and electronic medical records implementation (Meaningful Use). The myriad of new regulations, emerging trends, and government focus areas is constantly evolving and is overwhelming for many organizations.

This presentation will focus attention on those key issues that are current and emerging hot risk areas in healthcare. It will provide a framework for organizations to direct their efforts and resources in a more targeted fashion , analyzing the OIG Work Plan, fraud alerts, recent Corporate Integrity Agreements, settlements, and other enforcement information. It will also provide ideas on how to mine your own data in ways similar to what the government is doing, in order to identify potential weak spots.

Attend this 60-minute webinar to understand the current fraud and abuse enforcement environment, and the specific emerging risk areas and strategies for dealing with those. Learn how to best use your existing resources and data to stay ahead of these government audits and investigations, and to improve your compliance activities in order to maintain that position going forward.

Areas Covered in the Webinar:

• A high-level overview of current laws and regulations impacting fraud and abuse cases
• A summary of some of the recent fraud and abuse cases
• Current ‘hot topics’ that regulators are targeting
• New and emerging laws and regulations that create additional challenges
• Strategies for identifying your own risks and focusing resources
• The power of data, both on the enforcement side and in your own organization.
• Key activities to build into your existing processes to keep your organization ahead of government audits.

Who Will Benefit:

This webinar will provide valuable assistance to healthcare personnel in medical offices, practice groups, hospitals, academic medical centers, health care billing companies, and healthcare consultants. Specific roles include:

• Compliance Director/Officer
• CEO
• COO
• CFO
• Revenue Cycle Director
• HIM Director
• Billing Office Personnel
• Information Systems Manager
• Internal Audit Personnel
• Medical Staff Leadership
• Denials Prevention, Management, and Appeals Personnel
• Risk Management Personnel
• Case Management
• Utilization Review
• Pharmacy Director
• In-House and Outside Counsel
• Purchasing/Materials Management Director
• Contracts Manager, including Physician Contracts

Instructor Profile:

Susan Walberg, JD, MPA, CHC has over 20 years’ experience in the healthcare field, both on the provider and the payer side. On the payer side, Susan’s experience includes medical underwriting, contract and benefit analysis, and Part B audits and investigations, both as desk and onsite audits. She worked for a number of years as a Regulatory Attorney and Privacy Officer for a very large multi-state health system, where she was responsible for the interpretation, analysis, and application/implementation of both state and federal laws (including HIPAA and the Deficit Reduction Act), as well as policy development and implementation. Susan also did a lot of work analyzing contracts to ensure compliance with Stark and Anti-Kickback requirements, and provided education to corporate and staff at the various entities on those topics as well as others. Susan was responsible for leading internal reviews and investigations, and directing overpayment situations. She collaborated closely with the business office, Information Security, Human Resources, Internal Audit, and other departments in order to ensure all impacted departments were fully aware in changing laws, policies, and enforcement activity. She was also involved in responding to privacy and security breaches, and helped develop the response process and related policies.

Susan has also worked as the Corporate Compliance Officer in two health systems, and managed the staff and facility compliance activities in those organizations, including developing Code of Conducts, conducting compliance program assessments, developing risk assessments, policies and procedures, board reports, education plans and tools, and Conflict of Interest processes. She had oversight of the physician documentation and coding team, and was responsible for assisting those activities as well as editing and presenting those reports, as needed, to the board and leadership. She provided analysis and consultations for questions related to fraud and abuse laws and operational requirements. She has worked in a teaching facility as the Interim Compliance Officer, developing and managing the Compliance Program in that organization and managing compliance incidents and government audits and investigations. She provided assistance in handling a self-disclosure as well as an accreditation review of the teaching program. She has both led and collaborated on attorney-client privileged audits and investigations, and has worked with a variety of regulators to response to their reviews. Most recently, Susan worked with a sub-contractor under CMS, providing support for fraud and abuse audits and policy analysis on Medicare Parts C and D.

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