2018 MCC & PLI Conference Friday classes

Friday June 8, 2018

8:00 – 8:45 am
Alec Alexander, JD, Deputy Administrator & Director, Center for Program Integrity, Centers for Medicare and Medicaid Services will be giving a presentation discussing the CMS Program Integrity initiatives.

8:45 – 9:45 am
Will Medicare Revoke Your Billing Privileges? Don’t Answer “No” Too Quickly

The Centers for Medicare & Medicaid Services (CMS) wields broad authority to revoke providers’ and suppliers’ Medicare billing privileges. This authority, one of CMS’s most potent program integrity tools, has been applied in seemingly draconian ways. This session addresses key issues for providers and suppliers facing revocation of billing privileges, including:

•           An overview of CMS’s revocation authority

•           How CMS is using this authority against provider and suppliers

•           Strategies for appealing revocation

SPEAKERS: Jessica L. Gustafson, JD, The Health Law Partners, Farmington Hills, MI
Donald Romano, JD, Foley & Lardner, Washington, DC

9:45 – 10:15 am
Halifax False Claims Act Case: The Relator’s Perspective with the Taxpayers Against Fraud Education Fund

Healthcare fraud is a persistent industry problem and costs taxpayers hundreds of millions of dollars a year. False Claims Act and qui tam whistleblowers can be one of the government’s strongest tools for combating this fraud, recouping taxpayer dollars, and protecting patients. This panel provides an inside look at a whistleblower’s experience through a discussion with a former whistleblower in the health care industry.

SPEAKERS: Elin Baklid-Kunz, MBA, CHC, CPC, CPMA, CCS, Relator, United States ex rel. Baklid-Kunz v. Halifax Hospital Medical Center
Jacklyn DeMar, JD, Director of Legal Education, Taxpayers Against Fraud Education Fund, Washington, DC

10:15 –10:30 am
Break

10:30 – 11:30 am
Disruptions and Impairments in the Physician Workplace: Practical Solutions to Tough Questions

When disruptive behavior or impairment potentially impact the quality of physician care, tensions can rise. This session examines the unique and parallel HR and medical executive committee (MEC) issues that can result. Topics will include:

•           Disruptive behavior — HR or MEC issue, or both? Pros and cons for pursuing each path

•           Impairments: disability, age, drugs/alcohol

•           “Fitness for duty tests” or other exams? Mandatory retirement?

•           Options when drugs/alcohol are suspected

SPEAKERS: Tizgel K. S. High, JD, Vice President, Associate General Counsel, LifePoint Health, Brentwood, TN
Mark W. Peters, JD, Labor and Employment Practice Group, Waller LLP, Nashville, TN

11:30 am – 12:30 pm
HIPAA in a Digital World: Taking the Paper out of Healthcare

Since passage of HIPAA, pocket-size supercomputers are now common. Outside healthcare, almost any transaction can occur digitally. Healthcare clings to paper and ink. Matt Fisher will talk to Deven McGraw, former HHS Office for Civil Rights Deputy Director for Health Information, and Lucia Savage, former HHS Office of the National Coordinator for Health IT Chief Privacy Officer, about HIPAA myths in a digital age, including

•           How technology can advance privacy & security

•           Why apps & application program interfaces are the future

•           How HIPAA encourages data sharing

•           How attorneys can break down barriers to digital solutions

SPEAKERS: Deven McGraw, JD, Chief Regulatory Officer, Citizen Corporation, Palo Alto, CA
Lucia Savage, JD, Chief Privacy and Regulatory Officer, Omada Health, San Francisco, CA
MODERATOR: Matthew Fisher, JD, Mirick O’Connell LLP, Worcester, MA

12:30 – 1:30 pm
LUNCH
Asset Protection Strategies and Estate Planning

1:30 – 2:00 pm
Break

CONCURRENT SESSION

2:00 – 3:00 pm
Private Equity Investments in Healthcare: Recent Trends, Regulatory Considerations, and Market Implications

Private equity (PE) firm investment in health care is trendy. Traditionally, PE firms focused investments into health care entities with high-reimbursement potential. Some PE firms are now expanding into other areas of health care, such as primary care and other strategic targets. This session will examine the factors driving these trends, as well as the regulatory and market implications, including:

•           How the strategy for PE in healthcare has changed in recent years and why

•           Regulatory and practical issues surrounding PE investments in healthcare

•           Implications of PE investments in physician practices for hospitals and health systems

•           Important considerations for physician practice owners and their advisors

SPEAKERS: Rud Blumentritt, JD, Horne LLP, Baton Rouge, LA
Thomas Hutchinson, JD, Krieg De Vault LLP, Carmel, IN

2:00 – 3:00 pm
Anatomy of a Physician Employment Agreement

Whether the physician employment agreement is with a hospital, group practice, or other health care organization, the terms of such agreement are critical for defining each party’s responsibilities and protecting the physician’s professional and economic interests. This panel will dissect key elements of a physician employment agreement, identify must-have provisions and common traps, discuss the negotiation process between physician and employer, provide legal and regulatory guidance, and address practical tips for entering into such agreements.

SPEAKERS: Kathleen L. DeBruhl, JD, Kathleen L. DeBruhl & Associates, LLC, New Orleans, LA
Arthur Rosenson, JD, Cohen, Rosenson & Zuckerman, LLC, Chicago, IL

CONCURRENT SESSION

3:00 – 4:00 pm
Negotiating Effective Payer-Provider Contracts

A point and counter-point conversation to maximize revenue, improve timeliness, and reduce disputes in payer-provider contacts. Topics will include:

•           Common contractual pitfalls that impact reimbursement levels

•           Pro-active language to address and encourage changing payment models

•           Best practices for managing claim authorizations, claims processing, and denials/appeals

SPEAKERS: Layna C. Rush, JD, Baker Donelson, Baton Rouge, LA
Michael Wilmoth, JD, COO, Praxis Healthcare Solutions, Plano, TX

3:00 – 4:00 pm
There’s No Such Thing as Free Lunch: The Application of Fraud and Abuse Laws in Telemedicine Deals

The spotlight on telemedicine remains bright. Increased regulation and reimbursement of telemedicine demands that providers carefully assess compliance with fraud and abuse laws. Understanding what fair market value is (FMV) and commercially reasonable is essential. Experienced telemedicine valuation and legal advisors will explore relevant transaction considerations, including the nuanced challenges of fraud and abuse laws and the FMV and commercial reasonableness analysis based on existing regulatory guidance and industry practices.

SPEAKERS: Christopher G. Fete, JD, Manager, Pinnacle Healthcare Consulting, St. Louis, MO
Lisa Schmitz Mazur, JD, McDermott, Will & Emery LLP, Chicago, IL

4:00 – 4:15 pm
Break

CONCURRENT SESSION

4:15 – 5:15 pm
Structuring Physician Super Groups: Key Regulatory Issues and Challenges

In light of the constantly changing health care environment and increased government scrutiny and enforcement actions, this session will utilize hypothetical scenarios to:

•           Look at the movement towards the formation of super groups

•           Explore the process from a regulatory, operational, and business vantage point

•           Provide an overview of the key regulatory compliance issues related to patient referrals and the performance of ancillary services by super groups.

SPEAKERS: Jayme R. Matchinski, JD, Officer, Greensfelder, Hemker & Gale, PC, Chicago, IL
Hayden S. Wool, JD, Partner Director, Garfunkel Wild PC, Great Neck, NY

4:15 – 5:15 pm NON-CLE
Fireside Chat on the Unionization of Physicians

This session will discuss formation of physician unions, including why physicians unionize, the potential benefits and pitfalls of unions, and various legal issues that may arise from unionization. The session will also provide practical insight and examples of when physicians have successfully used unions to accomplish their goals and the challenges they faced along the way.

5:15 – 6:00 pm
CLE ETHICS CREDIT ETHICS

Don’t Get Smacked: Ethical Obligations and Traps for the Unwary A physician and a lawyer will lead this interactive discussion on scenarios from the front lines of the opioid crisis that implicate medical ethics and the rules of professional conduct that apply to attorneys. Consent, confidentiality and their exceptions in both medical and legal practice will be addressed.

SPEAKERS: David J. Banayan MD, MSc, FRCPC, Assistant Professor, Section of Psychiatry & Medicine, Rush University Medical Center, Chicago, IL
Lisa D. Taylor, JD, Inglesino, Webster, Wyciskala & Taylor, LLC, Parsippany, NJ