Since the inception of the Medicare Advantage program and subsequently with Part D, CMS has continued to increase scrutiny of potential disconnects between sales, marketing and enrollment activities. With the increased risk of financial penalties and sanctions including suspension of marketing and enrollment, Medicare Advantage participants need to look closely at CMS’s evolving focus in their oversight and audit initiatives. Health plans need to know where the process will be tomorrow, in addition to understanding where it is today.

As an example, CMS is evolving its approach to auditing plans, moving to a proactive risk-based approach, with an emphasis on outcomes, as opposed to retroactive assessments and focus on policies or procedures. The key to success for health plans will lie in the efficiency, effectiveness and transparency of their compliance and risk management programs. Join us for a free webinar in which the presenters will: 

• Outline specific sales and marketing practices that should be monitored proactively, in addition to periodic audits
• Examine the warning signs that may indicate incorrect/unclear information being provided to enrollees
• Examine the key compliance risks created by the use of agents and brokers
• Recommended options for avoiding compliance violations and minimizing risks
• Provide recommendations for effective training, testing and documentation that can help mitigate the risks
• Discuss investigation protocols that can be used to evaluate complaints, makes determinations and manage corrective actions
• Outline the common compliance pitfalls and offer suggestions for avoiding them
• Review implications of new sales and marketing and compliance penalties in the October 9, 2009 proposed regulation

Who Should Attend

• Chief Compliance Officer
• Chief Financial Officer
• Director of Internal Audit
• Chief Risk Officer
• Director of Regulatory Affairs
• Legal/Regulatory Counsel

About the Presenter

Dorothy DeAngelis is a managing director in the FTI Forensic and Litigation Consulting segment and is based in Charlotte, N.C. Ms. DeAngelis specializes in assisting legal counsel and ultimate clients with regulatory compliance and operations matters within the managed care and pharmaceutical industries. Her consulting practice during the last seven years has focused on the intersection of compliance issues in business relationships among entities in those two industries. Prior to joining FTI, DeAngelis was a managing director at Huron Consulting Group and a director at KPMG. DeAngelis has more than 17 years of experience in managed care and health insurance regulatory compliance and operations.

Bruce Fried is a partner in Sonnenschein’s national Health Care and Public Law & Policy Strategies groups. He has been recognized by Chambers USA and ExpertGuides as one of the leading health care attorneys in the U.S. Mr. Fried is a health care law and policy expert who counsels and represents health plans, physician organizations, hospital groups, consumer organizations, health care information technology and data companies, pharmaceutical and biotech companies and other health care organizations with regard to Medicare, Medicaid, HIPAA and other federal health care programs and policies.

Mr. Fried has more than thirty years of experience in health care law and policy, both in the public and private sectors. He served as the Health Care Financing Administration's (HCFA, now CMS) Director of the Center for Health Plans and Providers where he was responsible for policy and operations for the Medicare program. Prior to that, Mr. Fried was Director of HCFA's Office of Managed Care where he managed the rapid growth of the Medicare managed care program.

Prior to joining the government, Mr. Fried was Vice President of Federal Affairs at FHP International Corporation, then one of the nation's largest managed care organizations. Mr. Fried served as Chief Coordinator of the 1992 Clinton/Gore Campaign's Health Care Advisory Group. After the election, he was a member of the President's Transition Health Policy Team.