BLOOMBERG BNA WEBINAR EVENT: Managed Care: Compliance and Enforcement
Thursday, August 29, 2013
1:00 PM - 2:30 PM ET
With increased government focus on health care fraud enforcement, managed care providers face an amplified risk of False Claims Act allegations. To protect themselves, managed care providers should take vigilant steps to ensure that they have comprehensive compliance programs in place.
The faculty for this program will address the expansion of False Claims Act cases and new theories being asserted by a growing number of plaintiffs and the qui tam bar, new compliance guidance, key considerations for developing or modifying a risk adjustment strategy that withstands government scrutiny, and how to develop effective compliance strategies and programs to incorporate these risks. The will also discuss recent enforcement actions, such as the WellCare trial in Florida and the Janke settlement and the outcomes of these actions, the expansion of risk adjustment, and the intersection of managed care with other considerations such as the Anti-Kickback Statute and medical loss ratios.
- Understand the evolving compliance requirements in the Medicare Advantage program.
- Find out about the current enforcement landscape related to Medicare Advantage risk adjustment issues.
- Learn practical considerations for MA organizations in light of recent industry and enforcement trends.
- Discover the use of risk adjustment principles in other areas, such as Medicaid managed care programs and the Affordable Care Act’s insurance exchanges.
Who would most benefit from attending this program?
This program is intended for individuals in the office of the general counsel, compliance office, internal audit and special investigations units in health plans and contracted provider groups / provider management services organizations with responsibility for sales and outreach functions, managed care contracting, and financial functions.
It is also intended for outside counsel who represent these entities in the areas of regulatory compliance, white collar defense, contracting, transactional due diligence and other financial arrangements.
Program Level: Intermediate.
Credit Available: This program’s CLE-credit eligibility varies by state.