institute on medicare and medicaid payment...

Program Sponsor

Institute on Medicare and Medicaid Payment IssuesMarch 25-27, 2020 | Baltimore Marriott Waterfront Hotel | Baltimore, MD

LEARN. NETWORK. ENGAGE.

2 Register Today | www.communities.healthlawyers.org/medicareandmedicaid2020

Planning CommitteeAndrew D. Ruskin, Program Chair

Thomas R. Barker

Emily J. Cook

Barbara D.A. Eyman

David Hoskins

Andrew B. Wachler

Learning Objectives• Regulations and enforcement initiatives related

to Medicare and Medicaid reimbursement

• The impact of emerging regulatory trends, recent case law, and legislative developments on health plans and various types of health care providers

• Reimbursement challenges faced by plans and providers

PROGRAM SPONSOR

LUNCHEON SPONSOR

SIGNAGE SPONSOR

ePROGRAM SPONSOR

ePROGRAM SPONSOR

Exhibitors• Besler

• DHG Health

• GME Solutions

• Government Data Services LLC

• JND eDiscovery

• McKay Consulting Inc

• PYA

• The van Halem Group – A Division of VGM Group, Inc

• Toyon Associates Inc

• TransUnion

• Trinity Healthcare Resources

If you are interested in exhibiting or sponsorship opportunities at this program, please contact [email protected]

Hotel InformationBaltimore Marriott Waterfront Hotel 700 Aliceanna Street Baltimore, MD Reservations: (800) 266-9432

Hotel accommodations are not included in the registration fee. AHLA has reserved a block of rooms at the Baltimore Marriott Waterfront Hotel at a discounted rate of $269. To make reservations, please call the hotel directly at (800) 266-9432. The group rate cutoff is March 3, 2020 and may sell out prior to this date.

Registration Fees:Postmarked and paid on or before March 16, 2020

$925 first AHLA Member

$850 each additional AHLA Member

$1,200 Non-Member

Postmarked and paid between March 17-20, 2020

$1,075 first AHLA Member

$1000 each additional AHLA Member

$1,350 Non-Member

Discounts (cannot be combined)

$100 off full applicable rate for In-House Counsel and Solo Practitioner

$600 AHLA Government/Academician/Public Interest Professional Member

$750 Government/Academician/Public Interest Professional Non-Member

$465 One-Day Attendance AHLA Member

$600 One-Day Attendance Non-Member

INSTITUTE ON MEDICARE AND MEDICAID PAYMENT ISSUES

3

Practice Group Luncheon(s)

$60 AHLA Members

$70 Non-Members

Continuing Education Credit InformationCLE/MCLE: AHLA will be applying for 19.75 credits (including 1.0 ethics credit) for 60-minute states and approximately 23.7 credits (including 1.2 ethics credit) for 50-minute states.

CPE: AHLA will be applying for 23.0 CPE credits.

AHLA is registered with the National Association of State Boards of Accountancy

(NASBA) as a sponsor of continuing profession-al education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be addressed to the National Regis-try of CPE Sponsors, 150 Fourth Ave. North, Suite 700, Nashville, TN 37219-2417. NASBA’s website is www.nasba.org.

CCB: AHLA will be applying for 23.7 Compliance Certification Board (CCB) credits.

Participants will be given a link to the Continuing Education Request form online. Forms must be completed and submitted to AHLA staff to receive credit. The sessions, unless otherwise designated, are intermediate to advance in level. This program is designed to be an update on developments in the area of Medicare and Medicaid reimbursement issues. There are no prerequisites or advanced preparations required to register for this group live program. Those seeking accounting credits should be familiar with the basic concepts and terminol-ogy associated with health law in order to obtain the full educational benefit of this program.

MembershipDues are $235 for those admitted to the Bar/graduated from college within the last four years; $355 for those admitted/graduated between four and seven years ago; and $400 for those admitted/graduated eight or more years ago. Dues are $120 for government employees and full-time academicians; $105 for paralegals, $125 for public interest professionals, and $100 for retired professionals. Include the applicable membership fee with your registration form and take advantage of the program registration fee for members.

Cancellations/ SubstitutionsCancellations must be received in writing by March 13, 2020 and sent to Dorothy John-son: [email protected]. Registration fee, minus the $150 administrative fee, will be refunded approximately 3-4 weeks following the program in the same form of tender as the original payment. Refunds will not be issued for cancellations received after the cancellation date, to include no-shows.

Substitutions will be accepted, in writing to AHLA ([email protected]), up to 2 business days prior to the event date on a one time basis. Note, that the registration fee is based on AHLA membership status of the individ-ual who actually attends the program. Non-mem-ber substitutes will be charged the fee difference if they are substituting for a member-discounted registration.

Transfer to an upcoming event within one year of equal or higher value is available on a one time basis only, and should be received in writing to AHLA ([email protected]) no later than 2 business days prior to the event. An administrative fee of $150 will be charged for a transfer request.

Special NeedsIf you have needs requiring special assistance or accommodations, including special dietary needs, or have questions about accessibility issues at the program, contact our special needs coordinator, Valerie Eshleman at (202) 833-0784 or [email protected].

Spouse/Guest FeeFor an additional $50 spouses and adult guests can register to attend the reception on Wednes-day and Thursday evenings and the breakfasts on Wednesday, Thursday, and Friday mornings. Children are welcome to attend these events at no additional charge.

TravelATC Travel Management (ATC) has negotiated discounts with Delta, Hertz, and Alamo to bring you special airfares and car rental rates lower than those available to the public. Discounts apply for travel for AHLA 2020 meetings, discounts available 3 days pre/post meeting start/end dates. Restrictions and a service fee may apply. ATC will also search for the lowest available fare on any airline.

ATC TRAVEL MANAGEMENT

1-800-458-9383

email: [email protected]

ATC is available for reservations from 8:30 am until 8:00 pm Eastern, Monday through Friday.

For the most up-to-date information and to register, visit our website at: www.healthlawyers.org/ medicareandmedicaid2020


Tuesday, March 24, 20205:00-7:00 pmRegistration and Information

Wednesday, March 25, 20207:00 am-5:50 pmRegistration and Information

CONCURRENT SESSIONS

8:00-10:00 amA. Fundamentals of Medicare

and Medicaid Reimbursement (not repeated)Thomas R. Barker

David E. Kopans

Travis Lloyd

• The key differences between the federal Medicare (Parts A-D) program and state Medicaid programs

• How the Medicare and Medicaid programs work, including what benefits they cover, how they are paying today, and what it takes for providers to get paid

• The complex regulation of Medicare and Medicaid managed care plans

• Up-to-date on the latest changes to the Medicare and Medicaid programs and where they are heading in the immediate future

B. 2019 Medicare and Medicaid Year In Review (not repeated)Hope Levy-Biehl

Colin McCarthy

Janus Pan

Dawn Perez-Slavinski

This session reviews 2019’s major reimburse-ment and compliance legal developments, including:

• Medicaid DSH litigation update and Medi-care Part C days litigation update

• Changes to bundled payments initiatives and value based payments programs

• New off-campus provider based reimburse-ment rules and co-location guidance

• State Medicaid expansions and work/ eligibility requirements

• New Provider Enrollment Affiliated Disclosure Rule

• Changes to HIPAA guidance and enforcement

C. HHS’ Regulatory Sprint to Coordinated Care (not repeated)Will Brady

Adam H. Greene

Julie Kass

10:00-10:15 amBreak

GENERAL SESSION

10:15-10:40 amWelcome and Program Overview

S. Craig Holden, AHLA President-Elect

Andrew D. Ruskin, Program Planning Chair

10:40-11:00 amKeynote Address

Eric Hargan

11:00-11:45 amMedicaid Update

Matt Salo

11:45-12:05 pmHHS OGC Update

Robert P. Charrow

12:05-12:25 pmOIG Update

Gregory E. Demske

12:25-1:35 pmLunch on your own or attend the networking and presentation luncheon hosted by the Reg-ulation, Accreditation, and Payment Practice Group, sponsored by HORNE LLP

Topic: Molecular Diagnostics in Medicare: Myths, Realities, and Practical Realities

Paul Gerrard

Vice President, McDermott+Consult-ing LLC

• The landscape of Medicare Administra-tive Contractors overseeing molecular diagnostics

• NCD 90.2, and what it means for coverage of next-generation sequencing tests with some interesting examples of how local coverage determinations interact with the NCD

• Regulations concerning coverage from the perspective of a former medical director

• The regulatory framework for test pricing and how it gets implemented

• How coverage, pricing, and claims process-ing relate to each other

• How MolDX, which oversees coverage and pricing across 28 states, operationally func-tions

This event is not included in the program reg-istration. Additional fee; limited attendance; pre-registration required.

CONCURRENT SESSIONS

1:45-3:15 pm Extended SessionsD. Another Peek Behind the

Curtain: The Interactions of DOJ, OIG, CMS and the HHS Office of General CounselKaren S. Glassman

Janet S. Nolan

Lisa Ohrin Wilson

• An insider’s perspective on how DOJ, OIG, CMS, and HHS Office of General Counsel (HHS OGC) interact during the course of investigations, litigation, review of selfdis-closures, and other government work

• The roles of each of the agencies in en-forcing critical fraud and abuse laws, such as the federal Antikickback Statute, the Physician Self-referral Law, and Medicare/Medicaid rules and regulations

• Tips for providers during investigations and self-disclosures

Agen

da

5Register Today | www.communities.healthlawyers.org/medicareandmedicaid2020

E. Mental Health, EKRA and The Opioid Crisis Lynn M. Barrett

Kimberly Brandt

Gary L. Cantrell

• Mental health issues focusing on individuals and entities impacted by the opioid crisis

• What we know (and don’t know) about EKRA

• CMS’s strategy to combat the opioid epidemic, including new Part B benefits for OTPs, Part D initiatives, and key guidances and flexibilities for state Medicaid programs

• Latest trends and enforcement strategies in the fight against prescription opioid diversion and fraud

F. 2019 Changes to Medicare and Medicaid Reimbursement for Telehealth and Communication Technology Based ServicesJacob Harper

Catherine Wong

Emily Yoder

• Medicare coverage for traditional “Tele-health Services” – where are we now?

• Experience after the first year of Medicare coverage for communication technolo-gy-based services

• Practical application for health systems and other stakeholders

• Medicare Advantage telehealth expansion

• Remaining gaps in coverage/opportunities for further expansion

G. Hospital Inpatient PPS UpdateAlyssa Keefe

Katrina A. Pagonis

H. Provider-Based Status, Under Arrangements, Enrollment, and Related Medicare RequirementsDanielle N. Adams

Andrew D. Ruskin

Lawrence W. Vernaglia

• Fundamentals of Medicare provider-based status

• Changes to payment for services in excepted and non-excepted provider-based clinics

• Strategies to maintain full Medicare reim-bursement for outpatient departments

• Litigation surrounding CMS’s actions and site-neutrality

• State law and commercial payor efforts toward site-neutrality and challenges to “facility fee” billing

2:15-3:15 pmI. Alina Case

Stephanie A. Webster

3:15-3:35 pmNetworking and Coffee Break, sponsored by PYA

3:35-4:35 pmJ. Introduction to Medical

Coding for Payment Lawyers (not repeated)Kimberly A. Lammers

Robert A. Pelaia

• The basics of procedural (CPT) and diagnosis (ICD-10) coding

• General guidance on use of the CPT & ICD coding manuals

• How to conduct research on coding issues

• Common legal/compliance issues based on coding

K. Medicaid Fundamentals: The Largest Coverage Source in the United States (not repeated)Craig H. Smith

Hemi D. Tewarson

• The evolution of Medicaid and key program components

• Medicaid expansion: Is your state in or out?

• Innovative state approaches to reforming Medicaid

• Federal and state Medicaid Program Integrity efforts

• Representing clients facing Medicaid program recoupments and sanctions

L. 340B Program Compliance and Current DevelopmentsSarah Lee

Barbara S. Williams

• The 340B drug discount program and com-pliance issues with an emphasis on matters that are related to Medicare and Medicaid reimbursement

• Perspective from the provider community and the 340B Prime Vendor

• Current developments in the 340B program, including GAO reports, guidance from HRSA and CMS, and a litigation update

M. Advanced Stark: The Dreaded Billing Statute

Robert A. Wade

• Why the Stark Law is essentially a billing statute

• Key areas that have imposed liability under the Stark Law

• Fair Market Value and Commercial Reasonableness standards

• Volume and Value: “Takes into Account”, “Varies With”, and “Relates To”

• Proposed changes

N. How Much Deference Do Courts Give to CMS these Days: A Review of Recent Court DecisionsSven Collins

The various deference standards that courts apply to different types of CMS actions are evolving; bedrock principles of interpretation are being questioned or overhauled. This session will explore:

• The implications for providers and CMS alike of recent deference cases, such as Kisor v. Wilke

• The circumstances and types of agency actions that receive deference and those that don’t

O. Key Issues in CMS/OIG Administrative Enforcement ActionsJulie Burns

Kirk Sripinyo

Judith A. Waltz

• Billing privileges revocations, exclusions, CMPs, and payment suspensions

• What issues can be appealed?

• Burden of proof/persuasion

• Standard of review

• Developing the record

Agenda

https://www.healthlawyers.org/Pages/In-Person-Details.aspx?MeetingId=2EC4DD91-1C10-E811-80D8-0050569E287F&TermBegins=07/01/2018&TermEnds=06/30/2019


Agen

da 4:50-5:50 pm

P. PRRB Appeals–The View from the Board Chair (not repeated)Clayton J. Nix

• Introduction of Board members

• Board decisions

• Jurisdiction

• Hearings

• Case inventory

• Board initiatives

• Electronic case tracking and filing

• Evaluation of decision process

• Observations from the Board

Q. Medicare Litigation Update (not repeated)Mimi H. Brouillette

Melissa Hart

• Past year’s significant Medicare reimburse-ment decisions issued by the federal courts as well as review of the relevant agency decisions at issue

• Litigation topics including: Jurisdiction; scope of the administrative record; substan-tive and procedural challenges (e.g., notice and opportunity to comment, contrary to law, and arbitrary and capricious); and rem-edies (e.g., remand orders and injunctions)

• Potential areas of future Medicare litigation implicated by the past year’s developments

• How courts and the agency have addressed the full spectrum of issues that might be applicable in Medicare litigation, thus giving attendees a better understanding of the strengths and weaknesses of ongoing reimbursement issues

R. Coverage, Coding, and Payment Issues for High Cost New Technologies: Spotlight on CAR-T Jugna J. Shah

Mark Trusheim

• Part A payments do not accommodate new technologies; understanding charge compression, NTAP, and outlier

• More national coverage analyses going forward

• Site of service issues related to large Part A and Part B payment differences

• CAR-T case-study: Looking under the Medicare hood

• Life after NTAP: What can we expect from Medicare for FY 2021?

• The pipeline and problems we must contemplate

• Payment innovations from other payers for Medicare to consider

S. Legal Ethics: The Grey Zone–Ethical Issues In Be-tween Compliance and LegalDawn R. Crumel

Kim Harvey Looney

• Intersection of Compliance and Legal in protecting the organization

• Communication and coordination issues when compliance and legal aren’t on the same page

• The role of Rules of Professional Conduct in these situations

• Reality of Compliance making independent reports to the board

• Hypothetical situations

T. Graduate Medical Education Finance: Hot Topics in Medi-care ReimbursementTim Johnson

Lori K. Mihalich-Levin

• Medicare payment for graduate medical education

• New CMS rules and commentary: Training at CAHs

• The Hahnemann fallout: Displaced Resident Status and Closed Hospital slot redistribution

• Medicare rules regarding newly-accredited residency and fellowship programs

• Proposals to modify Medicare GME Pay-ment Policy: Opioid Workforce and the Better Act of 2019

• Accreditation and funding proposals that attempt to influence practice locations of residents

U. The Federal Health Care Agenda in an Election Year, and BeyondEric Zimmerman

Conventional wisdom holds that Congress legislates only in odd numbered years. 2020 is likely to be different. Congress is poised to advance important health policy changes this year, and those changes could affect your

goals, strategies, and deals. The Administra-tion also has an ambitious regulatory agenda to establish its health policy record before the election. And candidates for the Democratic nomination for president are leading with health reform proposals. This session will look ahead to identify anticipated federal Medicare and Medicaid policy changes in 2020 and beyond, and assess how those changes could affect your interests.

• Surprise billing, prescription drug pric-ing, Medicaid DSH, and support for rural hospitals top Congress’s agenda

• The Administration is trying to remake the Medicaid program, complete its Regulatory Sprint, and finalize prescription drug pricing proposals

• Presidential candidates are talking Medi-care For All and other ACA changes

5:50-7:00 pmNetworking and Diversity+ Inclusion Reception, sponsored by PYA

Grab a drink and a few hors d’oeuvres after a full day of learning. Network with AHLA leaders and your fellow colleagues and learn more about AHLA’s diversity and inclusion initiatives. Attendees, faculty, and registered adult, teen, and youth guests are all welcome to attend.

Thursday, March 26, 20207:00 am-5:45 pmRegistration and Information

7:00-8:15 amContinental Breakfast, sponsored by PYA

This event is included in the program registration. Attendees, faculty, children, and registered spouses and guests welcome.

DEEPER DIVE

7:00-8:00 am (Limited to 20 Participants Each; Pre-Registration Required)

Interactive Session: DSH Medicare

Stephanie A. Webster (Moderator)


Agenda Interactive Session: Medicare GME

Lori K. Mihalich-Levin (Moderator)

• To the extent there is interest, we can dive deeper into the Hahnemann University Hospital closure situation and its implications for future residency program and hospital closures

• Rural training track issues may be top of mind, given unanswered accreditation and regulatory questions

• Bring any Medicare GME challenges you’d like to discuss

Interactive Session: 60 Day Repayment

Susan J. Banks (Moderator)

This session will be a guided discussion exploring a number of advanced issues that present interpretive and/or practical challeng-es when advising clients regarding compliance with the Federal Overpayments Statute and its 60-day report-and-return requirement. Hear from and exchange insights with fellow practitioners regarding real-world scenarios focusing on core themes, such as:

• How much and what kind of information is “credible information”?

• What does “reasonable diligence” really require?

• When can a failure of diligence start the repayment clock?

• Is it ever OK to report, but not return?

CONCRRENT SESSIONS

8:15-9:45 am Extended SessionsV. The Changing Face of the

Medicaid Program: A Review of Recent Trends in State Medicaid Waivers (not repeated)Ross D. Margulies

Marybeth Musumeci

W. Medicare Appeals: Soup to NutsR. Ross Burris III

Jason Green

Andrew B. Wachler

• In-depth explanation of the appeals process, what triggers the process, and what to expect at each stage

• Strategic approaches and practical tips to consider and implement when appealing over-payment demands and claim denials through the changing Medicare appeals process

• Timelines, standards of review, monetary requirements, and other important details involved in the audit process

• Updates on the Medicare appeals process, including HHS efforts to reduce the backlog of pending appeals and encouraging resolu-tion of cases earlier in the appeals process

• The impact recent regulations and initiatives will have on providers’ Medicare audit appeals

X. Hot Topics in Provider Enrollment: The Hot Topics Are Really Hot This YearLouise M. Joy

Emily W. Towey

Jeanne L. Vance

• New Medicare Enrollment Rule (taking Program Integrity to a new level-Dante?)

• OPPS Validation Edit Activation (and Enrollment record Spring Cleaning)

• Deactivation Rebuttals–(Don’t miss out; don’t mess up)

• Retroactive Medicare Enrollment Revocations and Denials (WMD?)

• Medicare Enrollment Appeals (Text book vs. real life)

• Best Practices for maintaining Medicare Enrollment Compliance (Easter eggs throughout)

Y. Hot Topics in Fraud and AbuseKatie Arnholt

Robert Kaufman

Laura F. Laemmle-Weidenfeld

• Recent developments in CMS’s program integrity efforts

• Recent priorities and developments in HHS-OIG enforcement efforts

• Recent enforcement activity by the DOJ under the FCA and criminal statutes

Z. Proactive Claims Auditing Strategies and Self- Disclosures under the Federal Overpayments Rule Susan J. Banks

Cornelia Dorfschmid

Matthew Westbrook

• A provider’s/supplier’s “report and return” obligations under the federal Overpayment Rule (SSA § 1128J(d)), including its intersection with the federal civil False Claims Act

• Implications of recent case law surrounding overpayment issues

• The boundaries of “credible information,” particularly in the context of routine or proactive documentation and coding compliance reviews

• The scope of the duty of “reasonable dili-gence” in the context of self-audits of paid claims and effective Compliance Programs, focusing on audit design considerations

• Practical issues arising in internal investiga-tions and proactive claims review strategies

8:45-9:45 amAA. Primer on Researching

Medicare and Medicaid Issues: Sources and Techniques (not repeated)

Eric Crowder

Lindsay Goldberg

• Strategies for developing a research plan and tips for effectively and efficiently conducting research

• Key primary and secondary sources for researching Medicare and Medicaid issues

• Research tips for avoiding pitfalls

• Practical considerations and real-life exam-ples

10:00-11:00 amBB. Current Issues in Medicaid

Supplemental Payments and Financing (not repeated)

Barbara D. A. Eyman

• The proposed Medicaid Fiscal Accountability Rule (MFAR)

• Medicaid disproportionate share hospital (DSH) and other Medicaid non-DSH supplemental payments

• Medicaid managed care directed payments

• Medicaid waiver payments, including uncompensated care payments and delivery system reform incentive program payments

• Medicaid financing (IGTs, CPEs, and provider taxes)



Agen

da CC. OMHA Appeals: Practice

tips from ALJs (not repeated)

David M. Glaser

Brian J. Haring

• Updates from the Office of Medicare Hearings and Appeals

• Tips from the ALJs, including how to use the record effectively in a phone hearing

• What information is available to the judge and how to ensure the record is complete

• How ALJs apply LCDs and contractor policies

DD. Escobar and Materiality: Practical Considerations

Joseph C. Hudzik

Natalie A. Waites

• The materiality standard under the FCA from Escobar

• Post-Escobar court decisions applying the materiality standard

• Does the difference between a condition of payment and a condition of participation matter anymore?

• Practical considerations when making a materiality assessment

• How materiality affects overpayment refund determinations

EE. Visits: Changing E&M Coding, Payment, and Documentation

Timothy P. Blanchard

• What’s retained from last year’s (CY 2019) Rule

o Burden reducing policies

• What’s new in the CY 2020 Rule

o New CPT Codes, definitions and instructions

o Updated visit RVUs, and no bundled payment amounts

o Changed choices for coding: Medical decision making OR time

• Outstanding policy issues

• Implications for compliance

FF. The Wages of Medicare are Complex: The Medicare Wage Index and Its Evolution

Daniel J. Hettich

Michael Treitel

After years of relatively static wage index policies, CMS enacted three new policies effecting the Medicare wage index in its 2020 Final Rule. Those policies were meant to address two of the more controversial aspects of the wage index: The calculation of a state’s rural floor, and the disparity between low and high wage index areas. These policies are themselves not without controversy, however. This session will discuss:

• The mechanics of the Medicare wage index focusing on potential areas of confusion or controversy

• Mechanisms for wage index reclassifica-tions, including MGCRB reclassifications and urban to rural reclassifications

• CMS’s new 2020 policies, including areas of dispute

• The practical implications of CMS’s new policies on hospital decision-making

U. The Federal Health Care Agenda in an Election Year, and Beyond (repeat)

Deeper Dive (Limited to 20 Participants Each; Pre-Registration Required)

CMMI–Deeper DiveTroy A. Barsky (Moderator)

• Moderated discussion with CMMI leader focused on current and future models

• Opportunity for in-depth small group discussion that will allow participants to explore CMMI models

• Participants will be afforded time to provide practical feedback to CMS regarding their current models, including what is working and areas for further development

• Question and answer session that will allow participants to engage in dialog with CMMI leadership

11:00-11:20 amNetworking and Coffee Break, sponsored by PYA

11:20 am-12:20 pmGG. It Don’t Mean A Thing If

It Ain’t Got Jurisdiction: Jurisdictional Principles and Issues for Appeals Before the PRRB and the Federal Courts (not repeated)

Jocelyn Beer

Kenneth R. Marcus

• Primer regarding basic jurisdictional and procedural requirements

• Lessons learned in 35 years in the “PRRB Zone”

• Frequently litigated jurisdictional issues

• Implications of the Supreme Court decisions in Allina and Kisor

HH. New Price Transparency Rules (not repeated)

Kelly M. Cleary

John E. Wyand

• What are the policy drivers behind the transparency rules?

• What is the statutory framework upon which the transparency rules are built?

• What do the transparency rules require–and related implications?

• What is the litigation landscape and where is it going?

• What are the policy and legislative issues going forward?

II. Update on the Convergence of Medicare vs IRS vs GAAP Revenue Recognition and Un-compensated Care ReportingFred A. Fisher

K. Michael Nichols

Mark D. Polston

• Federal and state programs using Medicare UC costs as the primary basis for hospital reimbursement for uncompensated care costs

• Present observations and key takeaways from recent worksheet S-10 audits

• GAAP revenue recognition requirements under “Topic 606” and its impact on the reporting of charity care and bad debt accounts


Agenda • The importance of capturing the true cost

of uncompensated care, while considering the differences between Medicare; IRS and GAAP guidance

• Present national and regional trends measuring UC cost from data in the CMS Healthcare Cost Report Information System (HCRIS)

• UC cost categories as they relate to CMS in-structions and hospital financial assistance policies

L. 340B Program Compliance and Current Developments (repeat)

M. Advanced Stark: The Dread-ed Billing Statute (repeat)

R. Coverage, Coding, and Payment Issues for High Cost New Technologies: Spot-light on CAR-T (repeat)

12:20-1:20 pmLunch on your own

CONCURRENT SESSIONS

1:35-2:35 pm

JJ. Tangoing with the Govern-ment in the CHOW Dance: Avoid Missteps with Medi-care Changes of Ownership (not repeated)

Judy Strobos

Nesrin G. Tift

• CHOW situations and their impact

• Benefits and burdens of accepting v. rejecting automatic assignment of the Medicare provider agreement

• Successor liability v. revenue gaps

• Reimbursement impacts

• Non-CHOW situations and their impact

• A walk-through of hypothetical transactions

KK. What’s New and Now in Part B: Updates to the Medicare Physician Fee Schedule and Quality Payment Program (not repeated)

Cynthia Brown

Sidney S. Welch

• Important content and implications of the Final Physician Fee Schedule for 2020

• The fundamental elements of calculation of physician reimbursement

• Quality Payment Program updates

• Other new developments in and operational realities of the MPFS

N. How Much Deference Do Courts Give to CMS these Days: A Review of Recent Court Decisions (repeat)

O. Key Issues in CMS/OIG Administrative Enforcement Actions (repeat)

DD. Escobar and Materiality: Practical Considerations (repeat)

EE. Visits: Changing E&M Coding, Payment, and Documentation (repeat)

Deeper Dive (Limited to 20 Participants Each; Pre-Registration Required)

Addressing Social Determinants of Health through Medicaid Managed Care: Progress and Challenges–Deeper Dive (not repeated)

Ross D. Margulies (Moderator)

Michael McKnight

2:55-3:55 pmLL. Medicaid Litigation Update

(not repeated)Garrett F. Mannchen

Felicia Y. Sze

• Litigation affecting Medicaid expansions and work requirements, lockouts, and other features in Medicaid waivers

• Recent cases challenging State rate decisions and payment methodologies

• Drug rebate program and rate setting litigation challenging CMS statutory interpretations

• Recent managed care cases

• Challenges to CMS policy on determination of DSH hospital-specific limit

• Medicaid coverage of benefits

MM. Medicare Advantage: Key Issues and Recent Developments (not repeated)

Anthony H. Choe

Mark E. Hamelburg

• Recent trends

• CMS policy updates

• Oversight and enforcement

• Plan-provider trends

• Looking ahead

NN. Key Recent CMS Innovation Initiatives: Exploration of Policy and Legal Issues

Troy A. Barsky

Margia K. Corner

• Key Initiatives: Medicare Shared Savings Program and Next Generation ACO Model, Radiation Oncology Model, Direct Contract-ing Model, Comprehensive Care for Joint Replacement Model

• The legal authorities underpinning the development and evolution of these models

• Practical implementation issues faced by health care organizations and practitioners as they adapt to these to new payment models

• The common legal issues and concerns that arise in structuring participation in these Innovation Models

o Fraud and Abuse Compliance

o Participation in Multiple Models

o Managing Risk and State Licensure

I. Alina Case (repeat)

T. Graduate Medical Education Finance: Hot Topics in Medi-care Reimbursement (repeat)



Agen

da FF. The Wages of Medicare are

Complex: The Medicare Wage Index and Its Evolu-tion (repeat)

3:55-4:15 pmNetworking and Coffee Break, sponsored by PYA

4:15-5:45 pm Extended SessionsOO. Current and Emerging

Issues in Rural Medicare Policy (not repeated)

Carol Blackford (invited)

Emily J. Cook

Kerri Cornejo

Sarah Heppner

• Traditional rural provider types and reim-bursement methodologies and recent up-dates/changes to rural provider payments

• Why rural providers and the policies that apply to them have implications for a broader audience

• Regulatory issues as they relate to rural health care providers

• New emerging and innovative care delivery and payment models taking place in rural communities

• Recent research into rural care delivery models

E. Mental Health, EKRA and The Opioid Crisis (repeat)

F. 2019 Changes to Medicare and Medicaid Reimbursement for Telehealth and Commu-nication Technology Based Services (repeat)

D. Another Peek Behind the Curtain: The Interactions of DOJ, OIG, CMS and the HHS Office of General Counsel (repeat)

G. Hospital Inpatient PPS Update (repeat)

H. Provider-Based Status, Under Arrangements, Enroll-ment, and Related Medicare Requirements (repeat)

5:45-6:45 pmNetworking Reception, sponsored by PYA

This event is included in the program registration. Attendees, faculty, children, and registered spouses and guests welcome.

Friday, March 27, 20207:00 am-12:30 pmRegistration and Information

7:00-8:15 amContinental Breakfast, sponsored by PYA

This event is included in the program registration. Attendees, faculty, children and registered spouses and guests welcome.

7:00 -8:00 amDeeper Dive (Limited to 20 Participants Each; Pre-Registration Required)

Interactive Session: 340BBarbara S. Williams (Moderator)

• HRSA enforcement authority on patient definition and other 340B compliance issues

• State initiatives to combat discriminatory practices against 340B providers

• Maximizing use of the 340B program

Interactive Session: Enrollment Rule, Billing, and Coding

Jeanne L. Vance (Moderator)

CONCURRENT SESSIONS

8:15-9:45 am Extended Sessions

PP. PRRB Appeals Current Challenges (not repeated)

Christine M. Blowers

Leslie D. Goldsmith

Lisa Ogilvie-Barr

Owen Osaghae

• OH CDMS overview and updates

• Jurisdictional, procedural, and case man-agement concerns

• Avoiding pitfalls and applying best practic-es before the Board

• Emerging trends

W. Medicare Appeals: Soup to Nuts (repeat)

X. Hot Topics in Provider Enrollment: The Hot Topics Are Really Hot This Year (repeat)

Y. Hot Topics in Fraud and Abuse (repeat)

Z. Proactive Claims Auditing Strategies and Self-Dis-closures under the Federal Overpayments Rule (repeat)

10:00-11:00 amQQ. OPPS Update for 2020

(not repeated)Marc Hartstein

Valerie Rinkle

• Major policy and payment provisions of the program

• Significant payment changes for drugs, procedures and devices

• Major policy changes for 2020 and implications

• Site neutral issues

• New and continuing operational and compliance challenges OPPS presents

• Price transparency requirements for 2021

RR. Home Health and Hospice Legislative and Regulatory Update (not repeated)

William A. Dombi

• The new Medicare home health payment model: PDGM


Agenda • Medicare home health Review Choice

Demonstration program: A new era in claims compliance

• Update on hospice payment methods

• Hospice quality of care compliance reforms to Medicare survey and certification

• Assorted regulatory reforms in home health and hospice

S. Legal Ethics: The Grey Zone–Ethical Issues In Between Compliance and Legal (repeat)

II. Update on the Convergence of Medicare vs IRS vs GAAP Revenue Recognition and Uncompensated Care Reporting (repeat)

NN. Key Recent CMS Innova-tion Initiatives: Exploration of Policy and Legal Issues (repeat)

11:15-11:45 amSS. FQHCs and RHCs:

Telehealth and Payment Innovations

Robert L. Coffield

Susannah Vance Gopalan

For federally-qualified health centers (FQHCs) and rural health clinics (RHCs), telehealth offers an alternative to traditional in-person visit, and e-health services, such as virtual communication services and e-consults, allow FQHC/RHC clinicians to provide their patients with cost-effective, timely and focused interventions. Telehealth plays a growing role in addressing provider shortages and in ensuring FQHC/RHC patient access to critical behavioral health and primary care services. In this brief session, we will cover:

• FQHC/RHC telehealth payment mechanisms in Medicare and Medicaid–the nuts, bolts, and differences

• Medicare and Medicaid policies on tele-health payment–the role of FQHCs/RHCs

• Recent e-health developments, such as payment to FQHCs/RHCs in Medicare for virtual communication services

• Overcoming regulatory obstacles when implementing telehealth services in FQHCs/RHCs

TT. How Counting Beds May Impact IME Reimbursement

Christopher L. Francazio

David J. Vernon

• How do beds affect Medicare Indirect Med-ical Education reimbursement to academic medical centers and teaching hospitals?

• What the regulations instruct us to do

• Suggested process to count beds

• Creating internal controls for yearly compliance

UU. Diagnostic Imaging IssuesThomas W. Greeson

• Requirements for use of clinical decision support mechanisms to consult appro-priateness criteria for orders of advance diagnostic imaging services for Medicare outpatients

• Will CMS decide to make mandatory consultation of appropriate use criteria operational in 2021?

• The use of mid-level practitioners (PA/NPs/RAs/RPAs) to perform diagnostic tests and minimally invasive radiology procedures

• When “incident to” billing may be available in radiologists’ offices when mid-level ancillary personnel are used to perform physician services

• Case studies regarding use of mid-level practitioners in radiology

VV. Bundled Payment Proposals, Their Future, and How Post-Acute Providers Such as SNFs and HHAs Fit In

Michael H. Cook

John R. Feore

• Bundled payment initiatives including BPCI Advanced and the Comprehensive Joint Replacement programs

• The future of bundled payments that address single diseases or conditions, including the results of CMS studies in the first two years of CJR as well as any other reports that are available

• Impact on post-acute providers including SNFs and HHAs

• Practical ideas of how our clients can play

WW. Clinical Laboratories Update: What’s New and What’s New (Again)

Jesse A. Berg

• Status of Protecting Access to Medicare Act (PAMA), including implications of 2019 Laboratory Access for Beneficiaries Act on PAMA reporting

• CMS guidance to state survey directors on “shared laboratories”

• 2019 CLIA proposed regulations

• Clinical laboratory date of service billing requirements and other developments from recent HHS rulemakings

• Key subregulatory developments, including major revisions to State Operations Manual (laboratory chapter) and new approach to penalties for proficiency testing referrals and inter-lab communication

• Hot fraud and abuse developments for clinical labs and discussion of clinical lab enforcement actions

12:00-12:30 pmSS. FQHCs and RHCs:

Telehealth and Payment Innovations (repeat)

TT. How Counting Beds May Impact IME Reimbursement (repeat)

UU. Diagnostic Imaging Issues (repeat)

VV. Bundled Payment Proposals, Their Future, and How Post-Acute Providers Such as SNFs and HHAs Fit In (repeat)

WW. Clinical Laboratories Update: What’s New and What’s New (Again) (repeat)

Adjournment



Prog

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Wednesday, March 25, 20207:00 am-5:50 pm

Registration and Information

8:00-10:00 am

A. Fundamentals of Medicare andReimbursement (not repeated)

Barker KopansLloyd

B. 2019 Medicare and Medicaid YearIn Review (not repeated)

Levy-Biehl McCarthyPanPerez-Slavinski

C. HHS’ Regulatory Sprint to Coordinated Care (not repeated)

BradyGreeneKass

10:00-10:15 am

Break

10:15 am- 12:25 pm GENERAL SESSION

10:15-10:40 amWelcome and Program Overview

Holden, Ruskin

10:40-11:00 amKeynote Address

Hargan

11:00-11:45 amMedicaid Update

Salo

11:45 am-12:05 pmHHS OGC Update

Charrow

12:05-12:25 pmOIG Update

Demske

12:25-1:35 pm

Lunch on your own or attend the networking and presentation luncheon hosted by the Regulation, Accreditation, and Payment Practice Group, sponsored by HORNE LLP

TOPIC: Molecular Diagnostics in Medicare: Myths, Realities, and Practical RealitiesGerrard

(This event is not included in the program registration. Additional fee; limited attendance; pre-registration required)

Tuesday, March 24, 20205:00-7:00 pm



Program Schedule

Wednesday, March 25, 2020 Condtinued

1:45-3:15 pm Extended Sessions

D. Another Peek Behind the Cur-tain: The Interac-tions of DOJ, OIG, CMS and the HHS Office of General Counsel

GlassmanNolanWilson

E. Mental Health, EKRA and The Opioid Crisis

BarrettBrandtCantrell

F. 2019 Chang-es to Medicare and Medicaid Reimbursement for Telehealth and Communication Technology Based Services

HarperWongYoder

G. Hospital Inpa-tient PPS Update

Keefe Pagonis

H. Provider- Based Status, Under Arrangements, Enrollment, and Related Medicare Requirements

AdamsRuskinVernaglia

2:15-3:15 pm

I. Alina Case

Webster

3:15-3:35 pm

Networking and Coffee Break, sponsored by PYA

3:35-4:35 pm

J. Introduction to Medical Coding for Payment Lawyers (not repeated)

LammersPelaia

K. Medicaid Fun-damentals: The Largest Coverage Source in the United States (not repeated)

SmithTewarson

L. 340B Program Compliance and Current Develop-ments

LeeWilliams

M. Advanced Stark: The Dread-ed Billing Statute

Wade

N. How Much Deference Do Courts Give to CMS these Days: A Review of Recent Court Decisions

Collins

O. Key Issues in CMS/OIG Administrative Enforcement Actions

BurnsSripinyoWaltz

4:50-5:50 pm

P. PRRB Appeals–The View from the Board Chair (not repeated)

Nix

Q. Medicare Liti-gation Update(not repeated)

Brouillette Hart

R. Coverage, Coding, and Pay-ment Issues for High Cost New Technologies: Spotlight on CAR-T

ShahTrusheim

S. Legal Ethics: The Grey Zone–Ethical Issues In Between Compli-ance and Legal

CrumelLooney

T. Graduate Med-ical Education Finance: Hot Top-ics in Medicare Reimbursement

JohnsonMihalich-Levin

U. The Federal Health Care Agenda in an Election Year, and Beyond

Zimmerman

5:50-7:00 pm

Networking and Diversity+Inclusion Reception, sponsored by PYA(This event is included in the program registration. Attendees, faculty, children, and registered spouses and guests welcome)



Prog

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e Thursday, March 26, 20207:00 am-5:45 pm


7:00 am-8:15 am

Continental Breakfast, sponsored by PYA(This event is included in the program registration. Attendees, faculty, children, and registered spouses and guests welcome)

7:00-8:00 am (Limited to 20 Participants Each; Pre-Registration Required)

Deeper Dive–Interactive Session: DSH Medicare

Webster (Moderator)

Deeper Dive–Interactive Session: Medicare GME

Mihalich-Levin (Moderator)

Deeper Dive–Interactive Session: 60 Day Repayment

Banks (Moderator)


V. The Changing Face of the Med-icaid Program: A Review of Recent Trends in State Medicaid Waivers (not repeated)

MarguliesMusumeci

W. Medicare Appeals: Soup to Nuts

BurrisGreenWachler

X. Hot Topics in Provider Enrollment: The Hot Topics Are Really Hot This Year

JoyToweyVance

Y. Hot Topics in Fraud and Abuse

ArnholtKaufmanLaemmle- Weidenfeld

Z. Proactive Claims Auditing Strategies and Self-Disclosures under the Federal Overpayments Rule

BanksDorfschmidWestbrook

AA. Primer on Researching Medicare and Medicaid Issues: Sources and Techniques (not repeated)

CrowderGoldberg

10:00-11:00 amBB. Current Issues in Medicaid Supplemental Payments and Financing (not repeated)

Eyman

CC. OMHA Ap-peals: Practice tips from ALJs (not repeated)

GlaserHaring

DD. Escobar and Material-ity: Practical Consider-ations

HudzikWaites

EE. Visits: Changing E&M Coding, Payment, and Documenta-tion

Blanchard

FF. The Wages of Medicare are Complex: The Medicare Wage Index and Its Evolu-tion

HettichTreitel

U. The Federal Health Care Agenda in an Election Year, and Beyond(repeat)

Zimmerman

Deeper Dive–CMMI Limited to 20 Participants Each; Pre- Registration Required

Barsky (Moderator)

11:00-11:20 am



Program Schedule

Thursday, March 26, 2020 Continued

11:20 am-12:20 pm Extended Sessions

GG. It Don’t Mean A Thing If It Ain’t Got Jurisdiction: Jurisdictional Principles and Issues for Appeals Before the PRRB and the Feder-al Courts (not repeated)

BeerMarcus

HH. New Price Transparency Rules (not repeated)

ClearyWyand

II. Update on the Convergence of Medicare vs IRS vs GAAP Revenue Recognition and Uncompensated Care Reporting

FisherNicholsPolston

L. 340B Program Compliance and Current Develop-ments (repeat)

LeeWilliams

M. Advanced Stark: The Dreaded Billing Statute (repeat)

Wade

R. Coverage, Coding, and Payment Issues for High Cost New Technolo-gies: Spotlight on CAR-T (repeat)

ShahTrusheim

12:20-1:20 pm

Lunch on your own

1:35-2:35 pmJJ. Tango-ing with the Government in the CHOW Dance: Avoid Missteps with Medicare Changes of Ownership (not repeated)

StrobosTift

KK. What’s New and Now in Part B: Updates to the Medicare Physician Fee Schedule and Quality Pay-ment Program (not repeated)

BrownWelch

N. How Much Deference Do Courts Give to CMS these Days: A Review of Recent Court Decisions (repeat)

Collins

O. Key Issues in CMS/OIG Administra-tive Enforce-ment Actions (repeat)

BurnsSripinyoWaltz

DD. Escobar and Material-ity: Practical Consider-ations (repeat)

HudzikWaites

EE. Visits: Changing E&M Coding, Payment, and Documenta-tion(repeat)

Blanchard

Deeper Dive– Addressing Social Determinants of Health through Medicaid Managed Care: Progress and Challenges (not repeated)Limited to 20 Participants Each; Pre-Registration Required

Margulies (Moderator), McKnight

2:55-3:55 pm

LL. Medicaid Liti-gation Update (not repeated)

MannchenSze

MM. Medicare Advantage: Key Issues and Recent Develop-ments (not repeated)

ChoeHamelburg

NN. Key Recent CMS Innovation Initiatives: Explo-ration of Policy and Legal Issues

BarskyCorner

I. Alina Case (repeat)

Webster

T. Graduate Med-ical Education Finance: Hot Top-ics in Medicare Reimbursement (repeat)

JohnsonMihalich-Levin

FF. The Wages of Medicare are Complex: The Medicare Wage Index and Its Evolution (repeat)

HettichTreitel

3:55-4:15 pm




Prog

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e Thursday, March 26, 2020 Continued

4:15-5:45 pm Extended Sessions

OO. Current and Emerging Issues in Rural Medicare Policy (not repeated)

Blackford (invited)E. CookCornejoHeppner

E. Mental Health, EKRA and The Opioid Crisis (repeat)

BarrettBrandtCantrell

F. 2019 Chang-es to Medicare and Medicaid Reimbursement for Telehealth and Communica-tion Technology Based Services (repeat)

HarperWongYoder

D. Another Peek Behind the Cur-tain: The Interac-tions of DOJ, OIG, CMS and the HHS Office of General Counsel (repeat)

GlassmanNolanWilson

G. Hospital Inpa-tient PPS Update (repeat)

KeefePagonis

H. Provid-er-Based Status, Under Arrangements, Enrollment, and Related Medicare Requirements (repeat)

AdamsRuskinVernaglia

5:45-6:45 pm

Networking Reception, sponsored by PYA(This event is included in the program registration. Attendees, faculty, children, and registered spouses and guests welcome)

Friday, March 27, 20207:00 am-12:30 pm


7:00-8:15 am

Continental Breakfast, sponsored by PYA(This event is included in the program registration. Attendees, faculty, children, and registered spouses and guests welcome)

7:00 -8:00 am (Limited to 20 Participants Each; Pre-Registration Required)

Deeper Dive–Interactive Session: 340B

Williams (Moderator)

Deeper Dive–Interactive Session: Enrollment Rule, Billing, and Coding

Vance (Moderator)


PP. PRRB Appeals Current Challenges (not repeated)

BlowersGoldsmithOgilvie-BarrOsaghae

W. Medicare Appeals: Soup to Nuts(repeat)

BurrisGreenWachler

X. Hot Topics in Provider Enrollment: The Hot Topics Are Really Hot This Year(repeat)

JoyToweyVance

Y. Hot Topics in Fraud and Abuse(repeat)

ArnholtKaufmanLaemmle-Weidenfeld

Z. Proactive Claims Auditing Strategies and Self-Disclosures under the Federal Overpayments Rule (repeat)

BanksDorfschmidWestbrook


Program Schedule

Friday, March 27, 2020 Continued

10:00-11:00 am

QQ. OPPS Update for 2020 (not repeated)

HartsteinRinkle

RR. Home Health and Hospice Legislative and Regulatory Update (not repeated)

Dombi

S. Legal Ethics: The Grey Zone–Ethical Issues In Between Compliance and Legal (repeat)

GhattasLooney

II. Update on the Con-vergence of Medi-care vs IRS vs GAAP Revenue Recognition and Uncompensated Care Reporting (repeat)

FisherNicholsPolston

NN. Key Recent CMS Innovation Initiatives: Exploration of Policy and Legal Issues (repeat)

BarskyCorner

11:15-11:45 am

SS. FQHCs and RHCs: Telehealth and Payment Innovations

Coffield Vance Gopalan

TT. How Counting Beds May Impact IME Reimbursement

FrancazioVernon

UU. Diagnostic Imaging Issues

Greeson

VV. Bundled Payment Proposals, Their Future, and How Post-Acute Providers Such as SNFs and HHAs Fit In

M. CookFeore

WW. Clinical Laboratories Update: What’s New and What’s New (Again)

Berg

12:00-12:30 pm

SS. FQHCs and RHCs: Telehealth and Payment Innovations (repeat)

CoffieldVance Gopalan

TT. How Counting Beds May Impact IME Reimbursement(repeat)

FrancazioVernon

UU. Diagnostic Imaging Issues(repeat)

Greeson

VV. Bundled Payment Proposals, Their Future, and How Post-Acute Providers Such as SNFs and HHAs Fit In (repeat)

M. CookFeore

WW. Clinical Labora-tories Update: What’s New and What’s New (Again)(repeat)

Berg



Program Planning Committee

Andrew D. Ruskin, Program Chair, Morgan Lewis & Bockius LLPWashington, DC

Thomas R. Barker Foley Hoag LLPWashington, DC

Emily Jane CookMcDermott Will & Emery LLPLos Angeles, CA

Barbara D. A. EymanEyman Associates PCWashington, DC

David HoskinsSupervisory Litigation Attorney, Office of the General CounselUS Department of Health and Human ServicesWashington, DC

Andrew B. WachlerWachler & Associates PCRoyal Oak, MI

________________________________ Danielle N. AdamsCenters for Medicare and Medicaid ServicesWashington, DC

Katie ArnholtDeputy Branch Chief, Administrative and Civil Remedies Branch Office of the Inspector General, US Department of Health and Human Services Washington, DC

Susan J. BanksDentons US LLPDenver, CO

Lynn M. BarrettBarrett Law PAPembroke Pines, FL

Troy A. BarskyCrowell & MorningWashington, DC

Jocelyn BeerSupervisory Litigation AttorneyOffice of the General Counsel, US Depart-ment of Health and Human ServicesWashington, DC

Jesse A. BergLathrop GPM LLPMinneapolis, MN

Carol Blackford (invited)Deputy Director, Chronic Care Policy GroupCenters for Medicare and Medicaid ServicesWindsor Mill, MD

Timothy P. BlanchardBlanchard Manning LLPOrcas, WA

Christine M. BlowersLead AuditorNational Government Services Inc.Indianapolis, IN

Will BradyDeputy Secretary’s OfficeUS Department of Health and Human ServicesWashington, DC

Kimberly BrandtPrincipal Deputy Administrator for Operations and PolicyCenters for Medicare and Medicaid ServicesBaltimore, MD

Mimi H. BrouilletteGreenberg Traurig LLPDenver, CO

Cynthia BrownVice President, Government AffairsAmerican Medical AssociationWashington, DC

Julie BurnsAttorneyOffice of the General CounselUS Department of Health and Human ServicesBaltimore, MD

R. Ross Burris IIIPolsinelli PCAtlanta, GA

Gary L. CantrellDeputy Inspector General for InvestigationsOffice of the Inspector GeneralUS Department of Health and Human ServicesWashington, DC

Robert P. CharrowGeneral CounselOffice of the General CounselUS Department of Health and Human ServicesWashington, DC

Anthony H. ChoePolsinelli PCWashington, DC

Kelly M. ClearyDeputy General Counsel and Chief Legal OfficerCenters for Medicare and Medicaid ServicesUS Department of Health and Human ServicesWashington, DC

Robert L. CoffieldFlaherty Sensabaugh Bonasso PLLCCharleston, WV

Sven CollinsSquire Patton BoggsDenver, CO

Michael H. CookLiles Parker PLLCWashington, DC

Kerri CornejoHealth Resources & Services Administration, Office of Rural Health PolicyRockville, MD

Margia K. CornerPrincipal CounselUniversity of California Office of the PresidentOakland, CA

Eric CrowderHall Render Killian Heath & Lyman PCAnnapolis, MD

Dawn R. CrumelManaging Counsel, Legal Operations and AdministrationVanderbilt University Medical CenterNashville, TN

Gregory E. DemskeChief CounselOffice of the Inspector GeneralUS Department of Health and Human ServicesWashington, DC

William A. DombiPresidentNational Association for Home Care & HospiceWashington, DC

Cornelia DorfschmidExecutive Vice PresidentStrategic Management Services LLCAlexandria, VA

John R. FeoreAvalere HealthWashington, DC

Fred A. FisherToyon Associates IncCosta Mesa, CA

Facu

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FacultyChristopher L. FrancazioPKFHealth LLCBoston, MA

David M. GlaserFredrikson & ByronMinneapolis, MN

Karen Schandler GlassmanSenior CounselOffice of the Inspector GeneralUS Department of Health and Human ServicesDallas, TX

Lindsay GoldbergOffice of the General Counsel - CMS DivisionUS Department of Health and Human ServicesWashington, DC

Leslie Demaree GoldsmithBaker Donelson Bearman Caldwell & Berkowitz PCBaltimore, MD

Jason GreenAdministrative Law JudgeOffice of Medicare Hearings and AppealsUS Department of Health and Human ServicesArlington, VA

Adam H. GreeneDavis Wright Tremaine LLPWashington, DC

Thomas W. GreesonReed Smith LLPMcLean, VA

Mark E. HamelburgSenior Vice PresidentAmerica’s Health Insurance PlanWashington, DC

Eric HarganDeputy SecretaryUS Department of Health and Human ServicesWashington, DC

Brian J. HaringDeputy Chief Administrative Law JudgeOffice of Medicare Hearings and AppealsUS Department of Health and Human ServicesArlington, VA

Jacob HarperMorgan Lewis & Bockius LLPWashington, DC

Melissa HartOffice of the General CounselUS Department of Health and Human ServicesWashington, DC

Marc HartsteinPrincipalHealth Policy Alternatives Inc.Washington, DC

Sarah HeppnerPolicy Research Division DirectorFederal Office of Rural Health PolicyHealth Resources and Services AdministrationRockville, MD

Daniel J. HettichKing & Spalding LLPWashington, DC

Joseph C. HudzikLatham & Watkins LLPWashington, DC

Tim JohnsonSenior Vice PresidentGreater New York Hospital AssociationNew York, NY

Louise M. JoyJoy & YoungAustin, TX

Julie KassBaker Donelson Bearman Caldwell & Ber-kowitz PCBaltimore, MD

Robert KaufmanOffice of the General Counsel-CMS DivisionUS Department of Health and Human ServicesWashington, DC

Alyssa KeefeVice President, Policy and AnalysisFederation of American HospitalsWashington, DC

David E. KopansJones DayColumbus, OH

Laura F. Laemmle-WeidenfeldJones DayWashington, DC

Kimberly A. LammersBaird Holm LLPOmaha, NE

Sarah LeeManager340B Education and Compliance SupportChapel Hill, NC

Hope Levy-BiehlDavis Wright Tremaine LLPLos Angeles, CA

Travis LloydBradley Arant Boult Cummings LLPNashville, TN

Kim Harvey LooneyWaller Lansden Dortch & Davis LLPNashville, TN

Garrett F. MannchenOffice of the General CounselUS Department of Health and Human ServicesWashington, DC

Kenneth R. MarcusHonigman Miller Schwartz and Cohn LLPDetroit, MI

Ross D. MarguliesFoley HoagWasington, DC

Colin McCarthyMcGuireWoods LLPRichmond, VA

Michael McKnightSenior Vice President of Policy and InnovationGreen & Healthy Homes InitiativeWashington, DC

Lori K. Mihalich-LevinDentons US LLPWashington, DC

Marybeth MusumeciAssociate Director at the Program on Medicaid and the UninsuredKaiser Family FoundationWasington, DC

K. Michael NicholsAVP ReimbursementRush University Med CenterChicago, IL

Clayton J. NixPRRB ChairpersonOffice of HearingsCenters for Medicare and Medicaid ServicesWashington, DC



Janet S. NolanDeputy Associate General Counsel for Program IntegrityOffice of the General CounselUS Department of Health and Human ServicesWashington, DC

Lisa Ogilvie-BarrDirector, Division of Hearings and DecisionsOffice of HearingsBaltimore, MD

Owen OsaghaeDivision of Provider Audit OperationsCenters for Medicare and Medicaid ServicesBaltimore, MD

Katrina A. PagonisHooper Lundy & Bookman PCSan Francisco, CA

Janus PanBradley Arant Boult Cummings LLPNashville, TN

Robert A. PelaiaDeputy General CounselUniversity of South FloridaTampa, FL

Dawn Perez-SlavinskiBass Berry & Sims PLCWashington, DC

Mark D. PolstonKing & Spalding LLPWashington, DC

Valerie RinklePresidentValorize Consulting LLCMedford, OR

Matt SaloExecutive DirectorNational Association of Medicaid DirectorsWashington, DC

Jugna J. ShahPresidentNimitt Consulting IncSpicer, MN

Craig H. SmithHogan Lovells LLPMiami, FL

Kirk SripinyoDeputy Branch Chief, Affirmative Litigation BranchOffice of Counsel to the Inspector GeneralWashington, DC

Judy StrobosAssistant Regional CounselOffice of the General CounselUS Department of Health and Human ServicesDenver, CO

Felicia Y. SzeAthene LawSan Francisco, CA

Hemi D. TewarsonDirector, Health DivisionNational Governors AssociationWashington, DC

Nesrin G. TiftBass Berry & Sims PLCNashville, TN

Emily W. ToweyHancock Daniel & Johnson PCGlen Allen, VA

Michael TreitelCenters for Medicare and Medicaid ServicesBaltimore, MD

Mark TrusheimStrategic Director, NEWDIGSVisiting Scientist, Sloan School of Manage-ment Massachusetts Institute of Technology; President, Co-Bio ConsultingCambridge, MA

Jeanne L. VanceSalem & Green PCSacramento, CA

Susannah Vance GopalanFeldesman Tucker Leifer Fidell LLPWashington, DC

Lawrence W. VernagliaFoley & Lardner LLPBoston, MA

David J. VernonHooper Lundy & Bookman PCWashington, DC

Robert A. WadeBarnes & Thornburg LLPSouth Bend, IN

Natalie WaitesSenior Counsel, Health Care FraudCivil Fraud Section, US Department of JusticeWashington, DC

Judith A. WaltzFoley & Lardner LLPSan Francisco, CA

Stephanie Ann WebsterRopes & Gray LLPWashington, DC

Sidney S. WelchAkerman LLPAtlanta, GA

Matthew WestbrookSenior Counsel, Administrative and Civil Rem-edies BranchOffice of the Inspector GeneralUS Department of Health and Human ServicesWashington, DC

Barbara Straub WilliamsPowers Pyles Sutter & Verville PCWashington, DC

Lisa Ohrin WilsonSenior Technical AdvisorCenters for Medicare & Medicaid ServicesBaltimore, MD

Catherine WongAssistant CounselMercyChesterfield, MO

David R. WrightActing Deputy Center Director, Center for Clinical Standards and QualityCenters for Medicare and Medicaid ServicesBaltimore, MD

John E. WyandSquire Patton BoggsWashington, DC

Emily YoderDivision of Practitioner Services, Hospital and Ambulatory Policy GroupCenters for Medicare and Medicaid ServicesBaltimore, MD

Eric ZimmermanMcDermott Will & Emery LLPWashington, DC

Facu

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American Health Lawyers Association1620 Eye Street, NW, 6th Floor • Washington, DC 20006-4010

(202) 833-1100 • Fax (202)833-1105 • www.healthlawyers.org

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