Program subject to change. Please check back for updates.
By: Michael Sherman, Marketing Director, G2 Intelligence/Plain Language Media
Laboratories and their investors remain under federal and state regulatory and law enforcement scrutiny. Coupled with those investigations, labs are increasingly in disputes with commercial payors regarding the medical necessity and reimbursement of certain testing regimes.
Hear from a current lab compliance official and former federal prosecutor and OIG-HHS attorney regarding the current enforcement and compliance climate affecting laboratories, investors, operators, and referral sources.
Effective compliance can mean the difference between simple repayments and civil or criminal violations. Learn leading practices regarding lab compliance and what generally triggers enforcement actions and related-litigation.
Presenter: Ginger Appleberry, Associate General Counsel, Caris Life Sciences
Sales and marketing practices are a current focus of FCA investigations. The presentation will provide an overview and discussion of the Anti-kickback and Stark statutes including a discussion of the applicability of their respective “safe harbors” and/or exceptions to help you evaluate scenarios and avoid liability.
This session will provide a focused discussion on what labs are likely to encounter in the event of a payor audit—including audits by original Medicare, Medicare Part C Plans, Medicaid/Medicaid Managed Care, and commercial payors. In addition to establishing the framework for an audit/appeal process, speakers will address general considerations and practical tips that labs can implement to prepare for and respond to audits.
- Explanation of the audit process from initial records request through the stages of appeal.
- Practical considerations to position the lab as favorably as possible in response to a records request and during the initial stages of the audit process.
- Strategy considerations during the audit appeals process.
- Discussion of recent reforms and initiatives to resolve cases outside of the Medicare appeal process as well as speakers’ recent experience relating to audits and appeals.
Presenter: Diana W. Voorhees, Principal, DV & Associates, Inc.
Auditing and monitoring are crucial components of every Compliance Program. Internal or self-auditing detects deficiencies in stated or unstated policies, system communications, IT functions, coding and billing errors and numerous other snafus. Discovery leads to corrective actions and prevention of fraud, waste, and abuse. This session will allow participants to:
- Re-evaluate and implement auditing techniques and strategies.
- Consider risk areas and avenues that lead to noncompliance.
- Review examples of laboratory and pathology audit findings.