physicians and hospitals law institute february …...3 registration fees: postmarked and paid on or...

Physicians and Hospitals Law Institute February 10–12, 2020

Sheraton Grand Phoenix, Phoenix, AZ

LEARN. NETWORK. ENGAGE.

Platinum Level Sponsor

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Planning CommitteeJulie E. Kass, Program ChairDavid A. DeSimoneRick L. HindmandAnjana D. PatelSeth M. WolfKristen McDermott Woodrum

Learning Objectives• Current enforcement efforts and their impact on

physicians, hospitals, and health systems

• ACA implementation challenges for providers

• Regulatory developments and considerations

• Structuring integration models and delivery systems

Platinum Level Sponsor

Gold Level Sponsor

Silver Level Sponsor

Additional Sponsors

ExhibitorsAffiliated MonitorsCarnahan GroupCoker GroupHealthCare Compliance NetworkHMS Valuation PartnersHORNE LLPJND eDiscovery JTaylorNtractsPinnacle Healthcare ConsultingPYASullivanCotterVMG HealthWipfli LLP

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

Hotel InformationSheraton Grand Phoenix

340 North 3rd Street Phoenix, AZ (602) 262-2500

Hotel accommodations are not included in the registration fee. Call Sheraton Grand Phoenix and indicate that you are attending the AHLA program. Rooms at the group rate of $259 single/double occupancy are limited and may sell out prior to the January 24, 2020 cut-off.

PHYSICIANS AND HOSPITALS LAW INSTITUTE

3

Registration Fees:Postmarked and paid on or before January 24, 2020

$925 first AHLA Member

$850 each additional AHLA Member

$1200 Non-Member

Postmarked and paid after January 25-February 2, 2020*

$1,075 first AHLA Member

$1000 each additional AHLA Member

$1350 Non-Members

* Fees increase $100 after this date

Discounts

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

$600 AHLA Government/Academician/Public Interest Professional

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

$465 AHLA One-Day Attendance Member

$600 AHLA One-Day Attendance Non-Member

Practice Group Luncheon

$60 Member of sponsoring Practice Group(s)

$70 Non-Member of sponsoring Practice Group(s

Continuing Education Credit InformationCLE/MCLE: AHLA will be applying for 16.75 credits (including 2.0 ethics credit) for 60-minute states and approximately 20.1 credits (including 2.4 ethics credit) for 50-minute states.

CPE: AHLA will be applying for 20.0 CPE credits.

AHLA is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional 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 Registry 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 20.1 Compliance Certification Board (CCB) credits.

Participants will be given Continuing Education Request forms at the program. Forms must be completed and returned to AHLA staff to receive credit. The sessions, unless otherwise designat-ed, are basic in level. This program is designed to be an update on developments in the area of health law. 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 terminology 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 academi-cians; $190 for Solo Practitioner in Private Practice, $105 for paralegals, $125 for public interest professionals, and $100 for retired profession-als. 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 January 29, 2020 and sent to Dorothy Johnson: [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 individual who actually attends the program. Non-member substitutes will be charged the fee difference if they are substituting for a member-dis-counted 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 Monday and Tuesday evenings and the breakfasts on Tuesday and Wednesday mornings. Please sign up on the registration form. (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. Restric-tions 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/ physiciansandhospitals2020

DON’T REACT TO CHANGE. CREATE IT.It’s time to think differently about the business of healthcare.Let’s work together to see what’s possible.

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Monday, February 10, 20207:00 am-5:25 pm

Registration and Information

7:00-8:00 am

Continental Breakfast, sponsored by PYA and SullivanCotter

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

GENERAL SESSION

8:00-8:15 am

Welcome and IntroductionsS. Craig Holden, AHLA President-Elect

Julie E. Kass, Program Chair

8:15-10:15 am

Year in ReviewRobert G. Homchick

Kristen B. Rosati

Jack S. Schroder

Join us for a fast-paced overview of develop-ments over the past year:

• The Trump Administration “sprints” toward regulatory reform

• Health care reform continues to evolve

• Supreme Court imposes new limits on ju-dicial deference to agencies’ interpretation of ambiguous regulations

• Allina False Claims Act developments affect use of subregulatory guidance in affirma-tive enforcement actions

• Abuse of those involved in fraud and abuse ticks up a notch

• Opioid litigation hits new highs

• Health information privacy laws spiral

• Federal Parity Act adds bite to mental health coverage claims

• Providers face increased exposure to work-place violence and sexual abuse claims

10:15-10:35 am

Networking and Coffee Break, sponsored by HMS Valuation Part-ners and JTaylor

CONCURRENT SESSIONS

10:35-11:35 am

A. Sex, Drugs, and... Confiden-tiality: Privacy for Pediatric Patients (not repeated)Anthea R. Daniels

Michaela D. Poizner

• What does HIPAA say about allowing parents and other guardians access to minor patients’ records? [Hint: The answer is not always “parents have access to their children’s records.”]

• What role does state law play in determin-ing who has access to a minor patient’s records? Because state law directly impacts the HIPAA access analysis and may impose its own permissions and restrictions, it is essential to understand the relationship between HIPAA and state law on these matters

• At what point can a minor patient access his or her own medical records? When can a minor patient prevent his or her parent from accessing the records, and what role does payment for treatment have on the ability to access the records?

• What does the right to consent to treatment have to do with the right to access medical records? Turns out, everything. This session will provide a close look at the relationship between consent to treatment and access to records

• How should providers handle production of an electronic health record when a portion of the record can be disclosed to the patient’s parent and a portion of the record cannot be?

• If the law generally grants parents the rights to their children’s health records, does that right change if the child’s parents are divorced or if a parent has lost custodial rights, and how can providers know if they have the whole story? What rights do non-parental caretakers have?

B. Modernizing and Clarifying the Physician Self-Referral Reg-ulations: Big Changes Ahead?

Julie E. Kass

Lisa Ohrin Wilson

• CMS proposals related to fundamental, terminology, and requirements

• CMS proposals to recalibrate the scope and application of the regulations

• Proposals for new exceptions for limited re-muneration to a physician and the donation of cybersecurity technology

• Application of proposals to hypothetical non-compliance with the physician self-re-ferral law

C. Combining Gainsharing and Co-Management to Enhance Service Line PerformanceThomas E. Dutton

John Fink

• Best practices in gainsharing and comanagement arrangements

• Rationale for combining programs

• Program development approach

• Funds flow and compensation

• Valuation considerations

• Relevant legal agreements

D. The Long Arm of the Law: Compliance Challenges and Risks When Interacting with Law EnforcementAnne D. Armstrong

Kristy M. Kimball

• Police body cameras in the hospital–estab-lishing expectations with law enforcement with respect to activation and deactivation of body cameras, crafting hospital policies and procedures to protect privacy, legisla-tive solutions, and the implications of PHI being improperly captured on police body cameras

• Permissive vs. mandatory disclosures to law enforcement–just because you can disclose doesn’t mean you should–balanc-ing the interests of public policy, hospital safety, and patient privacy when HIPAA permits disclosure to law enforcement; avoiding common mistakes and tips for dealing with the overly zealous officer; and determining what PHI should be disclosed

Agenda


• Law enforcement moonlighting as hospital security personnel–is a police officer ever off duty? Crafting and enforcing policies and procedures to ensure security person-nel follow hospital policy and leave their law enforcement “hat” at the hospital door

• Finding common ground–overcoming chal-lenges in developing workable processes with law enforcement agencies in an era of heightened scrutiny

E. Medicare Audits Including the New Targeted Probe and Educate Program (TPE), and the Expansion of Settlement Conference Facilitation (SCF)Nancy J. Griswold

Andrew B. Wachler

This presentation will discuss the most recent developments and emerging issues in the Medicare audit landscape that have a direct impact on physicians, physician organiza-tions, hospitals, and health systems. The presentation will also discuss how these new developments will impact the aforementioned providers for years to come. Topics of interest the session will cover include, but are not limited to:

• The emerging legal issues in the Medicare Audit Appeal landscape, and the Chief ALJ’s perspective on how OMHA is dealing with the delays for ALJ hearings

• The most current expansions of the audit program. Specifically, the program will discuss the new CMS initiative, the Tar-geted Probe and Educate Program (TPE), how to respond to TPE audits, and defense strategies

• The expansion of the Settlement Confer-ence Facilitation eligibility requirements, and how virtually everyone waiting for an ALJ hearing date now has the opportunity to participate in SCF

• Compliance strategies to reduce audit risk

11:35 am-12:50 pm

Lunch on your own or attend one of these luncheons:

When Violence Comes Calling: Approaches to Today’s Com-mon (and Unfortunate) Violence, hosted by Health Care Liability and Litigation, In-House Counsel, Labor and Employment, and Medical Staff, Credentialing, and Peer Review Practice Groups, sponsored by JND eDiscovery

Montrece McNeill Ransom, Sarah E. Swank

OR

The Role of the Health Care System in Addressing Member Social Determinant, hosted by Physician Organizations Practice Group, sponsored by ECG Man-agement Consultants

Robin J. Fisk

Sally A. Kraft

Full descriptions are available online. This event is not included in the program reg-istration; there is an additional fee; limited attendance; pre-registration required. Continuing Education Credits are not available for the luncheons.

CONCURRENT SESSIONS

1:05-2:05 pm

F. New Expectations for Compliance Programs (Advanced) (not repeated)Rachael A. Honig

Karen Nelson

• Summary of recent DOJ publications

• Guidance expanding on the Filip factors (February 2017)

• Guidance Document on the Evaluation of Corporate Compliance Programs (April 2019)

• Guidelines for Taking Disclosure, Cooperation, and Remediation into Account in False Claims Act Matters (May 2019)

• New structure of compliance program assessments

• Three fundamental governmental inquiries

• How they integrate the former “seven

elements”

• New requirements beyond the traditional elements

• Cooperation credit

• Compliance program effects on sentencing and disposition

• New considerations that may warrant cooperation credit

• Advanced compliance program development

• Substantive compliance trends

• Anti-kickback rule revisions

• Affiliate disclosure requirements

• Case examples

G. The Ins and Outs of Physi-cian Practice Lease Arrange-ments to Achieve Hospitals and Physician Objectives (not repeated)Brigid M. Maloney

Jessica E. Stack

• Practice lease arrangements are a model for hospital-physician alignment that may be implemented as an alternative to em-ployment. When implemented thoughtfully, these arrangements can be tailored to achieve the objectives of both the hospital/health system and the physician group. As a result, the specific terms of these arrangements can vary widely.

• The presentation will use case studies and illustrative examples to discuss:

• Examples of practice lease arrangements for professional services and practice resources

• Objectives that may lead hospitals and physicians to pursue a lease arrangement

• The variation of specified services and the assignment of business risk

• The impact of these variations in relation to the valuation

• Potential regulatory hazards and compli-ance considerations

• Practical tools to avoid common misunder-standings and develop best practices for implementation and integration

• Specific cases and “war stories” from prior experience

Agen

da


H. Legal Ethics: Take Two Aspirin and Call Me in the Morning: A Prescription for Prudent and Ethical Repre-sentation of Physician Orga-nizations and/or PhysiciansKim Harvey Looney

Michael F. Schaff

• When is someone a prospective client?

• What duties do you owe a prospective client?

• When does the client relationship begin?

• Who is your client? Do you represent the organization or individuals within the organization?

• What duties do you owe your client?

• Under what circumstances is representa-tion a conflict?

• When can the Advice of Counsel defense be asserted?

• The Yates Memo and its impact on an organization’s leadership.

• Hypotheticals

I. There’s No Place Like Home: Remote Patient Monitoring and its Interplay with “Traditional” Telemedicine

Richelle D. Marting

Emily Wein

• The restrictive criteria for traditional tele-medicine under the Medicare program

• New remote patient monitoring and similar quasi-telemedicine services

• Compliance challenges with remote patient monitoring services

• Coding and billing for remote patient moni-toring; identification of common pitfalls and ambiguities

• Interplay with traditional telehealth services how RPM and other virtual care can work in tandem

• Distinct legal issues posed by telehealth that could potentially impact an RPM model such as limitations on use of certain modalities (e.g., asynchronous)

• Distinct business opportunities that RPM provides as compared to traditional telehealth

J. They’re Here–Exorcising Intruders in Your Connected DevicesScott Bennett

Elizabeth F. Hodge

Gerard M. Nussbaum

This presenters will discuss the benefits and role of connected devices, security concerns, and risk mitigation strategies. Specific topics include:

• Background on connected devices–what they are, uses for connected devices, data sharing

• Security risks and mitigation approaches

• Existing legal framework (e.g., HIPAA, FDA, FTC, GDPR, state laws)

• Acquisition and use due diligence (includ-ing roles of providers, health systems, manufacturers in securing devices)

2:05-2:25 pm

Networking Break and Coffee Break, sponsored by HMS Valuation Partners and JTaylor

2:25-3:25 pm

K. Landmines and Other Surprises: Anticipating and Addressing Unexpected Professional Review Action Issues (not repeated)Franklin D. Beahm

Patrick D. Souter

• Professional Review Actions are impacted by federal and state law including quality and privilege concerns and reporting re-quirements. These legal mandates provide a structure by which to analyze issues but many times there is not a quick answer

• The legal authorities impacting Professional Review Actions such as Health Care Quality Improvement Act

• Examples of unexpected events encountered by the presenters in the peer review process that may not have a clear resolution

• The approach taken to address the issues

• Engage the audience to obtain their input on how they would approach it

• The repercussions related to determining how to proceed

• Best practices approach to limit the occurrence of such unexpected events

L. Cannabis: The Past, the Present, the Future regarding Hemp, Medical and Recre-ational Cannabis, and the Myriad of Issues that Attorneys Should be Aware (not repeated)Richard Y. Cheng

Lisa M. Gora

• National overview of medical marijuana and hemp: how it started, where we are today and its impact on health care

• The highly diverse state-level legal frame-works versus the tension with federal law

• Counseling clients, physicians, and organi-zations on the legal implications of medical marijuana and hemp–the intrastate versus interstate issue, FDA concerns, the issue restoring/administering/consumption in health care facilities and its effect on federal health care programs

• The 2018 Farm Bill: What does it mean?

• The legality of hemp-based CBD at the federal and state level

• The future of CBD, hemp and medical marijuana: What to expect

• Barriers for clients getting involved in the marijuana industry: Banking, legal status, real estate, research, stigma

M. Price Transparency Rule Compliance, Informing the Patient, and Protecting the Hospital’s Commercial Interests: Mutually Exclusive Concepts?

Joseph Miller

Andrew D. Ruskin

• CMS’s recently published Pricing Transpar-ency Rules and related litigation

• The antitrust considerations: Increased competition or vehicle for collusion

• Implications for Medicare compliance

• Implications for relationships with payers

• Other potential approaches for increasing transparency

Agenda


N. Antitrust Issues in Physician-Hospital AlignmentMatthew C. Hans

Melissa Hill

Paul Wong

Independent, physician-owned-and-operated medical practices are increasingly rare. More and more, physicians want or need to align in some way with local hospital systems. In light of this trend, we discuss:

• The spectrum of physician-hospital alignment–from simply joining an open medical staff to direct employment, and everything between

• The economics of the various forms of alignment, and the potential antitrust issues involved with each type of alignment

• Price fixing?

• Exclusive dealing?

• Tying?

• Clayton Act violations (reductions in competition through merger)?

• An update on recent antitrust cases challenging physician-hospital transactions, including these cases among others:

• State of Washington v. CHI Franciscan, a lawsuit challenging a professional services arrangement between a hospital and a multi-specialty group as per se price fixing

• FTC and State of North Dakota v. Sanford Health, the government’s successful challenge to a hospital’s acquisition of a medical practice

• United-DaVita merger, a vertical merger of physicians and a payer in which both physician-hospital and physician-payer relationships were investigated

O. PHI in the Cloud–Cyber Threats are EverywherePamela E. Hepp

Cynthia F. Wisner

• Not just ransomware and phishing–cloud service providers and hosts

• OCR enforcement and class actions

• Public facing and discoverable PHI

• Responding to FBI notices and attorney- client privileged investigations

• Shared patients and other Covered Entities’ breaches

3:40-4:40 pm

P. Party Hopping in Multiple APMs–Primer on Managing Your Patients, Your Data, and Your Sanity (not repeated)Amanda M. Brown

Stephanie D. Willis

• CMS is leading the shift towards val-ue-based reimbursement and continues to issue both voluntary and mandatory alternative payment models (“APMs”) to promote risk sharing such as Primary Care First, Direct Contracting, Pathways to Success, BPCI Advance, CJR, and OCM. The emergence of these models introduces new regulations and implications that must be deeply understood prior to participation. Further, CMS has offered opportunities to participate in multiple models simul-taneously–which can be synergistic or detrimental. When determining which (if any) path to take, organizations must make thoughtful financial and strategic considerations.

• The presenters will cover:

– The available APM options

– Financial and strategic implications of APM participation structures

• Key challenges and regulatory issues of participating in multiple APMs including the balance of:

– Fraud and abuse laws and protections that may not protect or apply all APMs equally

– Different sets of clinical guidelines from multiple organizations

– Data and privacy restrictions associat-ed with distinct or overlapping patient populations

Q. Structuring and Valuing Service Arrangements Between Providers and Private Equity: Using the Captive Practice Manage-ment Model (not repeated)Annapoorani Bhat

Jeanna Palmer Gunville

• State Corporate Practice of Medicine Laws and impact on structure

• The business model including investor formation of a management services orga-nization (MSO)

• Types of arrangements and financial rationale

• Key legal and business considerations, including due diligence risk areas and regulatory compliance

• Appropriate valuation methodologies, and valuation considerations including impact of changes to operations

• Tools to finalize the arrangement

R. Opioid Enforcement and Compliance Considerations for Both Hospitals and Physicians Scott R. Grubman

Matthew Josephson

• Current government enforcement initiatives related to opioid fraud and abuse

• Perspectives from both a federal prosecu-tor and defense lawyer related to opioid enforcement and compliance steps that hospitals, executives, and medical profes-sionals should take to avoid liability

• Case studies/examples of hospitals and health systems being held liable for the actions of affiliated medical professionals and tips on what a hospital should do if it uncovers misconduct or diversion

S. Let the Data Run?Scott A. Weinstein

Paul H. Westfall

• The evolving nature of data flow between different entities

• Identifying and managing the source of data (data provenance) and accompanying legal requirements

• The recent ONC and CMS rulemaking rules concerning admission, discharge, and transfer feeds; data provenance require-ments; information blocking; and the offering of APIs

• Potential federal legislation and regulatory changes

E. Medicare Audits Including the New Targeted Probe and Educate Program (TPE), and the Expansion of Settlement Conference Facilitation (SCF) (repeat)

Agen

da


4:55-5:25 pm

T. Introduction to Information Blocking for Fraud and Abuse LawyersSeth M. Wolf

• OIG has proposed conditioning new safe harbors for value-based arrangements on information blocking compliance

• CMS has proposed including information blocking compliance as a requirement the donated EHR technology Stark exception

• The information blocking rule itself may result in significant penalties for noncompliance

• A high-level overview of the information blocking rule in the context of the Anti-Kickback and Stark statutes

• This session will be oriented to non- technology attorneys who provide guidance on Anti-Kickback and Stark issues

U. Emerging Legal Issues: Nurse Practitioners and Physician AssistantsCarolyn Buppert

• How to avoid Stark/kickback liability when the NP/PA is employed by the hospital

• Credentialing: How is it different from physicians?

• Billing: How to comply with Medicare’s incident-to rules

V. The Patient Safety Act: Implementation Strategies and Privilege Protections for Physician Groups and An-cillary ProvidersMichael R. Callahan

Ellen M. Flynn

• The Patient Safety Act and Status of Privi-lege Protections and court decisions to date

• Litigations lessons learned and impact on policy design and arguments to support assertion of the privilege

• Profile of a large physician group and issues addressed when contemplating whether to join a PSO

• Steps taken to obtain buy-in in order to obtain physician support and participation

• Infrastructure and committee design to achieve the privilege protection and goal of improving patient care

• Examples of quality initiatives and outcomes achieved by physician groups

W. Medicare Diagnostic Testing: A Regulatory CrossroadsDaniel F. Shay

• The intersection and interrelated aspects of various regulatory schema under Medicare as they affect diagnostic testing services in physician offices

• Reimbursement concepts including Inci-dent-to, the Anti-Markup Rule, and levels of physician supervision

• Concerns raised by compliance require-ments including Stark, and the False Claims Act

• How these requirements impact diagnostic testing in the context of physician offices and IDTFs

• The complicated connections between these concepts, how and when they apply, and the potential risks that Part-B suppliers face when rendering and documenting diagnostic testing services

X. Building the Bridge and Skinning the Cat: Mixing Metaphors for Managed Care Success (Advanced)Mark S. Kopson

• Recurring problems in managed care negotiations

• Tactics for getting past impasse

• Reasons for common managed care con-tract disputes

• How to avoid or minimize and survive disputes

5:25-6:30 pm

Networking and Diversity+ Inclusion Reception, sponsored by HORNE LLPThis event is included in the program registra-tion. Attendees, faculty, and registered guests are welcome.

Tuesday, February 11, 20207:30 am-5:15 pm


7:30-8:20 am

Networking Breakfast and Pre-sentation, hosted by AHLA’s Women’s Leadership Council, sponsored by Pinnacle Healthcare ConsultingThis event is included in the program registra-tion. Attendees and faculty are welcome; pre-registration is required. More information will be available online.

7:30-8:30 am

Continental Breakfast, sponsored by PYA and SullivanCotter

This event is included in the program registra-tion. Attendees, faculty, and registered guests are welcome.

CONCURRENT SESSIONS

8:30-9:45 am Extended Sessions

Y. Hedging Physician Risk in Value Based Programs (not repeated)David A. DeSimone

Brian S. Kern

John R. Washlick

• Bundled and other downside risk payment programs

• Using reinsurance to protect physicians in risk payment programs

• Legal and regulatory concerns of protecting downside risk

• Examples of risk payment programs:

• Medicare CJR

• BPCI

• Commercial: ASC joint bundle

Agenda


Agen

da Z. Emerging Issues in Federal

Healthcare Fraud: Everything You Need to Know About DOJ, OIG, and CMS Enforcement CollaborationA.G. Alexander

Joseph Beemsterboer

Gary L Cantrell

Michael R. Schulze

Presenters will discuss from the points of view of the primary enforcement agencies and impacted providers, the following:

• Current enforcement priorities and trends in health care

• Coordination and collaboration between DOJ, HHS-OIG and CMS and other law enforcement in health care fraud matters

• Recent DOJ health care fraud strike force takedowns across 23 federal jurisdictions

• Their significance with respect to possible future actions and the emerging role of data in identifying program vulnerabilities and pursuing fraud and

• New regulatory tools for identifying and preventing fraud

AA. Beyond the Buzzwords: Practical, Legal, and Financial Considerations for Implementing Value-Based Strategies (Advanced)

Justin Chamblee

Elizabeth R. Hammack

Kristen McDermott Woodrum

• An in-depth practical, legal, and financial analysis of the new reimbursement land-scape and model structures that are being contemplated

• The dynamics currently affecting physician compensation and reimbursement and how that impacts next year’s negotiation

• Practical, legal, and financial considerations for physician group structural changes, in-cluding entering/exiting Alternative Payment Models

• What changes health care entities can implement to their current and future com-pensation strategy to align incentives and with policy and quality measures

• The key challenges and opportunities asso-ciated with innovation

• the practical, legal and financial im-plications of new quality reporting and transparency requirements, including data integrity, collection, and analytics

BB. Fair Market Value in Health Care–The Seventh Annual Year in Review: A Whole New World or Just the Triple Grand Slam in the Middle of the World Series?

Kelly R. Anderson

Justin Burk

Andrea M. Ferrari

• A recap of 2019-2020 regulatory ac-tions, court cases, settlements, and other developments that focus on and/or otherwise relate to the concepts of fair market value and commercially reasonable in hospital-physician transactions, including developments relating to MACRA, ACOs, distressed hospitals and hospital bank-ruptcies, clinical integration, certificates of need, the proposed rules issued under the Regulatory Sprint to Coordinated Care (and related comments) and new and chang-ing developments and trends in criminal prosecutions rooted in compensation relationships

• How these developments might reflect, challenge and/or affect prevailing legal perspectives and operational processes regarding hospital-physician arrangements, including of what to look for and how to analyze relationships, and, in particular, how parties do or should approach ques-tions of fair market value and commercial reasonableness

• Our opinion of the Top Ten FMV issues of the year, including practical takeaways for counsel, compliance officers, healthcare executives and valuation analysts

CC. Taking Stock of Information Blocking

Mark A. Knee

Marilyn Lamar

Patricia A. Markus

The 21st Century Cures Act broadly defined “information blocking” and then directed the Secretary of the Department of Health and Human Services to identify, through rulemak-ing, “reasonable and necessary activities” that would not constitute information blocking be-fore enforcement of the rule could begin. Af-ter the proposed rule was published in March 2019, over 2,000 comments have been

received, and industry stakeholders continue to appeal to Congress in attempts to influence the content and timing of the final rule. This panel will highlight the major comments sub-mitted about the rule and, assuming the final rule is issued before the conference, will ex-amine the final rule’s provisions and suggest strategies to help assure compliance. Given the complexities of data sharing and the con-stantly changing technology environment, the effort needed to avoid information blocking activities and potential penalties of up to $1 million may rival the effort needed to comply with HIPAA. Specific topics to be addressed include:

• Key definitions and their impact on scope of the rule

• Types of activities likely to constitute infor-mation blocking

• Details of exceptions for privacy, security, and infeasible requests

• Reasonable costs and fees

• Compliance strategies

10:00-11:00 am

DD. Legal Ethics: When Inside Meets Outside–Principles and Practical Advice for In-House and Outside Physician and Hospital Lawyers (not repeated)

Anna-Liisa Mullis

Sadie Sullivan

• Conflicts. For in-house counsel, as health care entities merge and become more complex corporate conglomerates, there is an increased potential that the legal interests of the affiliates may not always be aligned or that other potential conflicts of interest may arise. For outside counsel, this ever changing landscape may also create potential conflicts of interest.

• The attorney-client privilege. For in-house and outside counsel, when the privilege arises, the scope of the privilege, and protecting the privilege. Often, this means starting with the threshold question of who is the client.

• Modern attorney-client communications. For in-house and outside counsel, establishing appropriate parameters on email and text message communications to ensure pro-tection of privileged or confidential informa-tion. Frequently, it is necessary to examine the specific context of the communication,


Agenda for example communications inside the company (e.g., between in house counsel and business leads of the company) and third party communications (e.g., between in house counsel representing the company and a third party).

• Engaging outside counsel and managing the relationship. When is it time to consider engaging outside counsel and best practic-es for navigating the in-house and outside counsel relationship. This may include ex-amining and harmonizing differing interpre-tations among inhouse and outside counsel concerning the requirements of the Model Rules of Professional Conduct, for example when the in-house legal department places restrictions on outside counsel (e.g., limiting the number of attorneys in meeting, limiting communications among outside counsel, re-quiring in-house approval if project exceeds five hours), or if in-house counsel instructs outside counsel to accept something as fact which may be contrary to other information outside counsel has received.

EE. Addressing Social Determi-nants in a Fraud and Abuse World (Advanced)

Tony R. Maida

Vicki L. Robinson

• The role of social determinants in val-ue-based health care

• The current anti-kickback statute (AKS) and beneficiary inducement statute (BIS) regulations regarding patient incentive arrangements

• Apply the regulations and OIG guidance to various patient incentive arrangements, in-cluding co-pay waivers, local transportation, items of nominal value, promoting access to care, and more

• OIG’s proposed changes to the AKS and BIS regulations and their potential impact on addressing social determinants

FF. Use of PHI for Non-Patient Purposes: Limits, Liability, and Vendors Who Do Not Care

Kim C. Stanger

Brent Wilson

• Limits applicable to PHI, including HIPAA, 42 CFR part 2, state privacy laws, consumer protection laws, contractual limits, etc.

• The limited scope of the “health care opera-tions” exceptions

• Limits on the business associate’s use of PHI for “data aggregation” or their own “business operations”

• Properly using limited data sets and de-identification to clear the way for use

• Controlling the use of PHI after it leaves your organization and other means of minimizing your liability

GG. Square Pegs and Round Holes–The Challenges of Applying Privacy Laws to Cloud Infrastructure Services

Adam H. Greene

• The specific provisions of business associate agreements, such as accounting of dis-closures requirements and the individual’s right of access, that may apply in unique ways when a cloud provider does not have knowledge of the data on its servers

• Contracting for and operationalizing a shared security model, in which each party needs to fully understand its role in protect-ing the data

• Unique challenges surrounding substance use disorder records and other sensi-tive conditions that have additional legal restrictions

• Emerging state general privacy laws, such as the California Consumer Privacy Act, and the complexity of applying their medical information preemptions to cloud services

• Breach reporting challenges, such as when it is appropriate to identify the cloud provid-er as involved in a breach

N. Antitrust Issues in Physician- Hospital Alignment (repeat)

11:15 am-12:15 pm

HH. Let’s Go to Tax Town! (not repeated)

Gerald M. Griffith

Jennifer L. Gurevitz

• Intersection of sections 4958 and 4960 excise tax costs of high end compensation packages

• Protecting against a section 501(r) audit of financial assistance and billing practices

• Managing the increased UBIT burden for tax-exempt organizations

• Rethinking how tax-exempt bonds affect management contracts under the latest safe harbors

• Tax-exemption for ACOs “The road so far”

II. Understanding the Impact of “Artificial Intelligence” on the Future Practice of Law and Medicine (not repeated)Gordon J. Apple

Haavi Morreim

• Whether searching for new uses of existing drugs, making a diagnosis, or recommend-ing the “best” treatment option, the use of Artificial Intelligence in numerous settings pose unique challenges for health care lawyers and providers in understanding just what it is, what are its benefits and, just as importantly, what are its risks and inherent limitations. This session will provide an overview of these challenges and will focus on how AI issues fit within the professional ethical responsibilities of health lawyers and the health care providers and the entities they serve. It will encourage audience participation in the context of a moderated discussion of these issues.

• AI 101–Exploring key concepts and vocabu-lary of AI. A discussion of concepts such as machine learning, the black box issue and automation bias.

• AI and Emerging legal challenges

• AI and standards of care. How might standards of care and causality in patient care be (re)defined. What happens if AI recommends a clinical pathway and the physician opts not to follow it; or if AI rec-ommends a pathway and the patient fares poorly because the physician, by following it, failed to exercise individualized clinical judgment. What about issues of bias on the part of those creating AI algorithms and their implementation. What regulatory/legal regimes will arise to address AI and what regulatory protections should be in place to prevent adoption of harmful technologies.

• AI and product liability. Several questions arise, including: What potential liabilities can manufacturers of AI incur when their sys-tems apparently cause an adverse outcome,

• AI and Emerging ethical issues

• For health care professionals: What are the ethical risks of using AI in patient care and in research


Agen

da • For lawyers: What baseline knowledge

will be necessary to advise clients on AI issues

• For patients: What are the privacy impli-cations of AI; to what extent and in what ways should patients be informed about the use of AI in their care; in what ways does AI become a “third-party” in the traditional provider/patient relationship

• Q&A and Discussion

JJ. Medical Practice Act and NPDB Reporting: Trends and Implications for Physicians and Hospitals

Eric J. Plinke

• What are the physician reporting obligations under state Medical Practice Acts

• Reporting considerations: Common excep-tions, confidentiality, immunity, and peer review

• NPDB reporting obligations and lookback at 2018 Guidebook update

• Developments leading to a new emphasis on professional reporting and the regulatory impact

• Heightened regulatory environment adds to considerations for physician and hospital counsel

I. There’s No Place Like Home: Remote Patient Monitoring and its Interplay with “Tradi-tional” Telemedicine (repeat)

O. PHI in the Cloud–Cyber Threats are Everywhere (repeat)

12:15 pm-1:30 pm

Lunch on your own or attend the one of these luncheons:

Leading the Way to Zero by Learning from the Ordinary, hosted by Hospitals and Health Systems Practice Group, spon-sored by Affiliated Monitors

Lisa D. Vandecaveye

OR

Current Trends in Health In-formation Exchange, hosted by Health Information and Technology Practice Group

Melissa A. Kotrys

Full descriptions are available online. This event is not included in the program registration. There is an additional fee; limited attendance; pre-registration required. Continuing Education Credits are not available for the luncheons.

CONCURRENT SESSIONS

1:45 -2:45 pm

KK. New, Cutting-Edge Affiliation Models and Health Care Law Implications (Advanced) (not repeated)

Antonia A. Peck

James Max Reiboldt

• The structure of transactional affiliations (from joint ventures to employment to mergers) today, and how they will change tomorrow

• In-depth look at cutting-edge affiliation models, including real-life examples and practical applications

• Affiliation inhibitors, including risk mitigation

• Legal/regulatory and economic consid-erations when completing a variety of affiliation models

• Economic (including valuation) consider-ations pertaining to such affiliations

• Lessons learned from recent transactional experiences

LL. Clinical Research: Seeking Increased Access to Innova-tion for Community Providers

Daniel O. Carroll

Eric D. Whitman

• Traditional industry sponsor research–practical issues related to the traditional approach to clinical research access and reliance on Sponsors and CROs finding investigative sites and/or investigative sites using Site Management Organizations to find studies

• Site collaborations–legal and clinical issues related to (a) investigative sites collaborat-ing with each other to leverage resources in order to provide a network of sites and increased patient populations to sponsors; and (b) investigative sites collaborating with research institutes and/or industry partners to access early phase research

• Research cooperatives–legal and clinical issues related to individual investigative sites participating in research cooperatives providing access to both federally funded and industry sponsored research protocols

• NCORP community sites and NCI designat-ed sites–legal and clinical issues related to consortiums and affiliations approved to receive federal grant funding directly for participation in research base protocols, including establishing the consortium or affiliation, satisfying federal requirements, allocating responsibilities, and ensuring clinical and administrative cooperation

B. Modernizing and Clarifying the Physician Self-Referral Regulations: Big Changes Ahead? (repeat)

D. The Long Arm of The Law: Compliance Challenges and Risks When Interacting with Law Enforcement (repeat)

M. Price Transparency Rule Compliance, Informing the Patient, and Protecting the Hospital’s Commercial Interests: Mutually Exclusive Concepts? (repeat)

2:45-3:00 pm

Snack and Beverage Break, sponsored by HMS Valuation Partners and JTaylor


Agenda 3:15-4:30 pm Extended Sessions

MM. Think Differently: A New Take on Managing Physician Compensation Arrangements (not repeated)

David M. Glaser

Adam Klein

Mindy Phillips

• What process should you use to determine FMV and commercial reasonableness, and what should your policy look like?

• Salary surveys have significant, poorly un-derstood flaws. How should you use them? What are the risks inherent in using survey data and how can you mitigate them?

• What do you do with physicians who are paid outside of policy limits (i.e., outliers)?

• Do you really “lose money on every physician?”

NN. The Regulatory Sprint to Coordinated Care and Value-Based Arrange-ments: Are We There Yet?

Tizgel K.S. High

Kim H. Roeder

This program will include discussion of the 2019 proposed amendments to the Physician Self-Referral Law rules and Anti-Kickback safe harbors relating to value-based and care coordination arrangements, from the perspec-tive of in-house counsel and outside counsel to health systems and physician practices:

• What has changed: A review of the proposed amendments to the Physician Self-Referral and Anti-Kickback rules relating to value-based and care coor-dination arrangements, including major issues identified by the industry that were addressed in the proposals.

• What remains the same: A review of restric-tions that may still apply and questions that may remain based on the proposed rules and preamble commentary.

• What opportunities exist for value-based and coordinated care arrangements based on the proposed rules, including a discussion of sample scenarios and business models.

• What compliance strategies may be needed to adapt to these proposals, such as:

– Managing compliance with proposed terms of exceptions and safe harbors, and

– Special challenges presented by value-based and coordinated care arrangements

888.739.7039 | [email protected]

Questions? Contact us!

EXECUTIVES | PHYSICIANS | ADVANCED PRACTICE PROVIDERS | EMPLOYEES Copyright © 2019 by SullivanCotter

SullivanCotter provides industry expertise, regulatory insight and market-leading physician compensation data to help our clients mitigate risk through an array of comprehensive fair market value and commercial reasonableness assessments and advisory support.

AHLA Physician and Hosiptals Law Institute meeting 11.5.19.indd 1 11/5/2019 3:59:46 PM


OO. The Patchwork of Federal and State Privacy Rules for Health Information: What Health Care Providers, Health Plans, and Vendors Handling Health Information Need to Know and Do Now

David S. Holtzman

Thora A. Johnson

Erika Riethmiller

• The relationship between federal and state privacy laws, including HIPAA, Part 2 (substance abuse), California’s Consumer Privacy Act (CCPA), and evolving data protection laws in Texas, Washington, New York, and Illinois

• Possible changes to information sharing under HIPAA, Part 2 (substance abuse), and CMS/ONC interoperability regulations, among providers and at the request of the individual

• Legal barriers in exchanging information (including de-identified information) for developing health insight and research, including ligation filed against Sutter Health, University of Chicago, and Google

• Actions in which state Attorneys General are using state laws, including unfair trade practices and consumer protection statutes to drive adoption of best practices for data protection and cybersecurity

Z. Emerging Issues in Federal Healthcare Fraud: Everything You Need to Know About DOJ, OIG, and CMS Enforce-ment Collaboration (repeat)

BB. Fair Market Value in Health Care–The Seventh Annual Year in Review: A Whole New World or Just the Triple Grand Slam in the Middle of the World Series? (repeat)

4:45-5:15 pm

T. Introduction to Information Blocking for Fraud and Abuse Lawyers (repeat)

U. Emerging Legal Issues: Nurse Practitioners and Physician Assistants (repeat)

V. The Patient Safety Act: Imple-mentation Strategies and Priv-ilege Protections for Physician Groups and Ancillary Providers (repeat)

W. Medicare Diagnostic Testing: A Regulatory Crossroads (repeat)

X. Building the Bridge and Skinning the Cat: Mixing Metaphors for Managed Care Success (Advanced) (repeat)

5:15-6:15 pm

Networking Reception, sponsored by HORNE LLPThis event is included in the program registra-tion. Attendees, faculty, and registered guests are welcome.

Wednesday, February 12, 2020 7:00 am-1:00 pm


7:00-8:00 am

Continental Breakfast, sponsored by PYA and SullivanCotterThis event is included in the program registration. Attendees, faculty, and registered guests are welcome.

CONCURRENT SESSIONS


AA. Beyond the Buzzwords: Practical, Legal, and Fi-nancial Considerations for Implementing Value-Based Strategies (Advanced) (repeat)

CC. Taking Stock of Information Blocking (repeat)

NN. The Regulatory Sprint to Coordinated Care and Value-Based Arrange-ments: Are We There Yet? (repeat)

OO. The Patchwork of Federal and State Privacy Rules for Health Information: What Health Care Providers, Health Plans, and Vendors Handling Health Information Need to Know and Do Now (repeat)

9:30-10:30 am

PP. Alternatives to Hospital Mergers (not repeated)

Thomas H. Hawk

Anjana D. Patel

• Recent trends impacting hospital non-merg-er transactions

• The affiliation spectrum and the continuum of strategic partnership structures

• Key legal issues involved with network formation, including fraud and abuse, tax, antitrust and other regulatory concerns and contractual provisions

• The features, benefits and disadvantages of each model

H. Legal Ethics Take Two Aspirin and Call Me in the Morning: A Prescription for Prudent and Ethical Representation of Physician Organizations and/or Physicians (repeat)

R. Opioid Enforcement and Compliance Considerations for Both Hospitals and Physicians (repeat)

S. Let the Data Run? (repeat)

Agen

da


10:45 am-11:45 am

QQ. Super Groups: Formation and Operational Issues (not repeated)

Mazen Asbahi

Jay Sanders

• The term “Super Group” refers to a single-spe-cialty, physician-owned, consolidated practice of generally three or more previously independent medical practices who have joined together as one legal entity billing under a single group NPI with separate strategic business units (“SBUs”). Super Groups are becoming increasingly more common as an alternative option available to physicians in private practice who desire bucking the trend of selling their practices to hospital systems or private equity backed ventures. This session shall provide an overview of key corpo-rate, regulatory and practical issues related to the formation and operation of Super Groups.

• Formation Issues

• Benefits vs costs

• Entity choice and formation structure

• Governance and authority issues

• Economic and accounting arrangements

• Stark Law and “group practice” concerns

• Incorporating ancillary services

• Path labs

• Anesthesiology / CRNAs

• Imaging centers

• Antitrust issues

• Operational Issues

• SBU operations

• Financings

• ASC affiliations and investments

• ACO exclusivity concerns

• Real estate matters

• Withdrawals of SBUs and individual members

C. Combining Gainsharing and Co-management to Enhance Service Line Performance (repeat)

FF. Use of PHI for Non-Patient Pur-poses: Limits, Liability, and Ven-dors Who Do Not Care (repeat)

GG. Square Pegs and Round Holes–The Challenges of Applying Privacy Laws to Cloud Infrastructure Services (repeat)

12:00 noon-1:00 pm

EE. Addressing Social Determinants in a Fraud and Abuse World (Advanced) (repeat)

JJ. Medical Practice Act and NPDB Reporting: Trends and Implica-tions for Physicians and Hospi-tals (repeat)

J. They’re Here–Exorcising Intrud-ers in Your Connected Devices (repeat)

LL. Clinical Research: Seeking In-creased Access to Innovation for Community Pro-viders (repeat)

Adjournment

Agenda




7:00-8:00 am

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

8:00-9:45 am

General Session8:00-8:15 am

Welcome and IntroductionsHolden, Kass

8:15-10:15 amYear in Review

Homchick, Rosati, Schroder

10:15-10:35 am

Networking and Coffee Break, sponsored by HMS Valuation Partners and JTaylor

10:35-11:35 am

A. Sex, Drugs, and... Confidentiality: Privacy for Pediatric Patients (not repeated)

DanielsPoizner

B. Modernizing and Clarifying the Physician Self-Referral Regulations: Big Changes Ahead?

KassL. Wilson

C. Combining Gainsharing and Co-Management to Enhance Service Line Performance

DuttonFink

D. The Long Arm of the Law: Compliance Challenges and Risks When Interacting with Law Enforcement

ArmstrongKimball

E. Medicare Audits Including the New Targeted Probe and Educate Program (TPE), and the Expansion of Settlement Conference Facilitation (SCF)

GriswoldWachler

11:35 am-12:50 pm

Lunch on your own or attend one of these luncheons:When Violence Comes Calling: Approaches to Today’s Common (and Unfortunate) Violence, hosted by Health Care Liability and Litigation, In-House Counsel, Labor and Employment, and Medical Staff, Credentialing, and Peer Review

Practice Groups, sponsored by JND eDiscoveryRansom, Swank

ORThe Role of the Health Care System in Addressing Member Social Determinants, hosted by Physician Organizations

Practice Group, sponsored by ECG Management ConsultantsFisk, Kraft

(This event is not included in the program registration; there is an additional fee; limited attendance; pre-registration required. Continuing Education Credits are not available for the luncheons.)

Prog

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7:00-8:00 am

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

8:00-9:45 am

General Session8:00-8:15 am

Welcome and IntroductionsHolden, Kass

8:15-10:15 amYear in Review

Homchick, Rosati, Schroder

10:15-10:35 am

Networking and Coffee Break, sponsored by HMS Valuation Partners and JTaylor

10:35-11:35 am

A. Sex, Drugs, and... Confidentiality: Privacy for Pediatric Patients (not repeated)

DanielsPoizner

B. Modernizing and Clarifying the Physician Self-Referral Regulations: Big Changes Ahead?

KassL. Wilson

C. Combining Gainsharing and Co-Management to Enhance Service Line Performance

DuttonFink

D. The Long Arm of the Law: Compliance Challenges and Risks When Interacting with Law Enforcement

ArmstrongKimball

E. Medicare Audits Including the New Targeted Probe and Educate Program (TPE), and the Expansion of Settlement Conference Facilitation (SCF)

GriswoldWachler

11:35 am-12:50 pm

Lunch on your own or attend one of these luncheons:When Violence Comes Calling: Approaches to Today’s Common (and Unfortunate) Violence, hosted by Health Care Liability and Litigation, In-House Counsel, Labor and Employment, and Medical Staff, Credentialing, and Peer Review

Practice Groups, sponsored by JND eDiscoveryRansom, Swank

ORThe Role of the Health Care System in Addressing Member Social Determinants, hosted by Physician Organizations

Practice Group, sponsored by ECG Management ConsultantsFisk, Kraft

(This event is not included in the program registration; there is an additional fee; limited attendance; pre-registration required. Continuing Education Credits are not available for the luncheons.)

Monday, February 10, 2020 continued1:05-2:05 pm

F. New Expectations for Compliance Programs(Advanced)(not repeated)

HonigNelson

G. The Ins and Outs of Physician Practice Lease Arrangements to Achieve Hospitals and Physician Objectives(not repeated)

MaloneyStack

H. Legal Ethics: Take Two Aspirin and Call Me in the Morning: A Prescription for Prudent and Ethical Representation of Physician Organizations and/or Physicians

LooneySchaff

I. There’s No Place Like Home: Remote Patient Monitoring and its Interplay with “Traditional” Telemedicine

MartingWein

J. They’re Here–Exorcising Intruders in Your Connected Devices

BennettHodgeNussbaum

2:05-2:25 pm

Networking Break and Coffee Break, sponsored by HMS Valuation Partners and JTaylor

2:25-3:25 pm

K. Landmines and Other Surprises: Anticipating and Addressing Unexpected Professional Review Action Issues (not repeated)

BeahmSouter

L. Cannabis: The Past, the Present, the Future regarding Hemp, Medical and Recreational Cannabis, and the Myriad of Issues that Attorneys Should be Aware(not repeated)

ChengGora

M. Price Transparency Rule Compliance, Informing the Patient, and Protecting the Hospital’s Commercial Interests: Mutually Exclusive Concepts?

MillerRuskin

N. Antitrust Issues in Physician-Hospital Alignment

HansHillWong

O. PHI in the Cloud–Cyber Threats are Everywhere

HeppWisner

3:40-4:40 pm

P. Party Hopping in Multiple APMs–Primer on Managing Your Patients, Your Data, and Your Sanity (not repeated)

BrownWillis

Q. Structuring and Valuing Service Arrangements Between Providers and Private Equity: Using the Captive Practice Management Model(not repeated)

BhatGunville

R. Opioid Enforcement and Compliance Considerations for Both Hospitals and Physicians

GrubmanJosephson

S. Let the Data Run?

WeinsteinWestfall

E. Medicare Audits Including the New Targeted Probe and Educate Program (TPE), and the Expansion of Settlement Conference Facilitation (SCF)(repeat)

GriswoldWachler

4:55-5:25 pm

T. Introduction to Information Blocking for Fraud and Abuse Lawyers

Wolf

U. Emerging Legal Issues: Nurse Practitioners and Physician Assistants

Buppert

V. The Patient Safety Act: Implementation Strategies and Privilege Protections for Physician Groups and Ancillary Providers

CallahanFlynn

W. Medicare Diagnostic Testing: A Regulatory Crossroads

Shay

X. Building the Bridge and Skinning the Cat: Mixing Metaphors for Managed Care Success(Advanced)

Kopson

5:25-6:30 pm

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

Program Schedule


Prog

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7:30 am-5:15 pm


7:30-8:20 am

Networking Breakfast and Presentation, hosted by AHLA’s Women’s Leadership Council, sponsored by Pinnacle Healthcare Consulting

(This event is included in the program registration. Attendees and faculty are welcome; pre-registration is required.)

7:30-8:30 am

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


Y. Hedging Physician Risk in Value Based Programs(not repeated)

DeSimoneKernWashlick

Z. Emerging Issues in Federal Healthcare Fraud: Everything You Need to Know About DOJ, OIG, and CMS Enforcement Collaboration

AlexanderBeemsterboerCantrellSchulze

AA. Beyond the Buzzwords: Practical, Legal, and Financial Considerations for Implementing Value-Based Strategies (Advanced)

ChambleeHammackWoodrum

BB. Fair Market Value in Health Care–The Seventh Annual Year in Review: A Whole New World or Just the Triple Grand Slam in the Middle of the World Series?

AndersonBurkFerrari

CC. Taking Stock of Information Blocking

KneeLamarMarkus

10:00-11:00 am

DD. Legal Ethics: When Inside Meets Outside–Principles and Practical Advice for In-House and Outside Physician and Hospital Lawyers (not repeated)

Mullis Sullivan

EE. Addressing Social Determinants in a Fraud and Abuse World(Advanced)

MaidaRobinson

FF. Use of PHI for Non-Patient Purposes: Limits, Liability, and Vendors Who Do Not Care

StangerB. Wilson

GG. Square Pegs and Round Holes–The Challenges of Applying Privacy Laws to Cloud Infrastructure Services

Greene

N. Antitrust Issues in Physician-Hospital Alignment(repeat)

HansHillWong

11:15 am-12:15 pm

HH. Let’s Go to Tax Town! (not repeated)

GriffithGurevitz

II. Understanding the Impact of “Artificial Intelligence” on the Future Practice of Law and Medicine(not repeated)

AppleMorreim

JJ. Medical Practice Act and NPDB Reporting: Trends and Implications for Physicians and Hospitals

Plinke

I. There’s No Place Like Home: Remote Patient Monitoring and its Interplay with “Traditional” Telemedicine(repeat)

MartingWein

O. PHI in the Cloud–Cyber Threats are Everywhere(repeat)

HeppWisner


Program Schedule

Tuesday, February 11, 2020 continued12:15 pm-1:30 pm

Lunch on your own or attend the one of these luncheons: Leading the Way to Zero by Learning from the Ordinary, hosted by Hospitals and Health Systems Practice Group, sponsored

by Affiliated MonitorsVandecaveye

ORCurrent Trends in Health Information Exchange, hosted by Health Information and Technology Practice Group

Kotrys(This event is not included in the program registration. There is an additional fee; limited attendance;

pre-registration required. Continuing Education Credits are not available for the luncheons.)

1:45 -2:45 pm

KK. New, Cutting-Edge Affiliation Models and Health Care Law Implications(Advanced)(not repeated)

PeckReiboldt

LL. Clinical Research: Seeking Increased Access to Innovation for Community Providers

CarrollWhitman

B. Modernizing and Clarifying the Physician Self-Referral Regulations: Big Changes Ahead?(repeat)

KassL. Wilson

D. The Long Arm of The Law: Compliance Challenges and Risks When Interacting with Law Enforcement(repeat)

ArmstrongKimball

M. Price Transparency Rule Compliance, Informing the Patient, and Protecting the Hospital’s Commercial Interests: Mutually Exclusive Concepts?(repeat)

MillerRuskin

2:45-3:00 pm

Snack and Beverage Break, sponsored by HMS Valuation Partners and JTaylor

3:15-4:30 pm Extended Sessions

MM. Think Differently: A New Take on Managing Physician Compensation Arrangements (not repeated)

GlaserKlein Phillips

NN. The Regulatory Sprint to Coordinated Care and Value-Based Arrangements: Are We There Yet?

HighRoeder

OO. The Patchwork of Federal and State Privacy Rules for Health Information: What Health Care Providers, Health Plans, and Vendors Handling Health Information Need to Know and Do Now

HoltzmanJohnsonRiethmiller

Z. Emerging Issues in Federal Healthcare Fraud: Everything You Need to Know About DOJ, OIG, and CMS Enforcement Collaboration(repeat)

AlexanderBeemsterboerCantrellSchulze

BB. Fair Market Value in Health Care–The Seventh Annual Year in Review: A Whole New World or Just the Triple Grand Slam in the Middle of the World Series? (repeat)

AndersonBurkFerrari

4:45-5:15 pm

T. Introduction to Information Blocking for Fraud and Abuse Lawyers(repeat)

Wolf

U. Emerging Legal Issues: Nurse Practitioners and Physician Assistants(repeat)

Buppert

V. The Patient Safety Act: Implementation Strategies and Privilege Protections for Physician Groups and Ancillary Providers(repeat)

CallahanFlynn

W. Medicare Diagnostic Testing: A Regulatory Crossroads (repeat)

Shay

X. Building the Bridge and Skinning the Cat: Mixing Metaphors for Managed Care Success (Advanced)(repeat)

Kopson

5:15-6:15 pm

Networking Reception, sponsored by HORNE LLP(This event is included in the program registration. Attendees, faculty, and registered guests are welcome.)


Prog

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e Wednesday, February 12, 2020 7:00 am-1:00 pm


7:00-8:00 am

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


AA. Beyond the Buzzwords: Practical, Legal and Financial Considerations for Implementing Value-Based Strategies (Advanced)(repeat)

ChambleeHammackWoodrum

CC. Taking Stock of Information Blocking(repeat)

KneeLamarMarkus

NN. The Regulatory Sprint to Coordinated Care and Value-Based Arrangements: Are We There Yet?(repeat)

HighRoeder

OO. The Patchwork of Federal and State Privacy Rules for Health Information: What Health Care Providers, Health Plans, and Vendors Handling Health Information Need to Know and Do Now(repeat)

HoltzmanJohnsonRiethmiller

9:30-10:30 am

PP. Alternatives to Hospital Mergers(not repeated)

Hawk Patel

H. Legal Ethics: Take Two Aspirin and Call Me in the Morning: A Prescription for Prudent and Ethical Representation of Physician Organizations and/or Physicians(repeat)

LooneySchaff

R. Opioid Enforcement and Compliance Considerations for Both Hospitals and Physicians (repeat)

GrubmanJosephson

S. Let the Data Run?(repeat)

WeinsteinWestfall

10:45 am-11:45 am

QQ. Super Groups: Formation and Operational Issues(not repeated)

AsbahiSanders

C. Combining Gainsharing and Co-management to Enhance Service Line Performance(repeat)

DuttonFink

FF. Use of PHI for Non-Patient Purposes: Limits, Liability, and Vendors Who Do Not Care(repeat)

StangerB. Wilson

GG. Square Pegs and Round Holes–The Challenges of Applying Privacy Laws to Cloud Infrastructure Services(repeat)

Greene


Program Schedule

Wednesday, February 12, 2020 continued12:00 noon-1:00 pm

EE. Addressing Social Determinants in a Fraud and Abuse World(Advanced)(repeat)

MaidaRobinson

JJ. Medical Practice Act and NPDB Reporting: Trends and Implications for Physicians and Hospitals(repeat)

Plinke

J. They’re Here–Exorcising Intruders in Your Connected Devices(repeat)

BennettHodgeNussbaum

LL. Clinical Research: Seeking Increased Access to Innovation for Community Providers(repeat)

CarrollWhitman

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Program Planning Committee

Julie E. Kass, Program Chair Baker Donelson Bearman Caldwell & Berkowitz PC Baltimore, MD

David A. DeSimone Senior Vice President, Transformation and Chief Legal Officer CentraState Healthcare System Freehold, NJ

Rick L. Hindmand McDonald Hopkins LLC Chicago, IL

Anjana D. Patel Epstein Becker & Green PC Newark, NJ

Seth M. Wolf Associate General Counsel University Hospitals Beachwood, OH

Kristen McDermott Woodrum BakerHostetler Atlanta, GA ______________

A.G. Alexander Deputy Administrator of CMS, Director of Centers for Program Integrity Department of Health and Human Services Washington, DC

Kelly R. Anderson Associate General Counsel Baptist Health Louisville, KY

Gordon J. Apple Law Offices of Gordon J Apple PC Saint Paul, MN

Anne D. Armstrong Senior Counsel Intermountain Healthcare Salt Lake City, UT

Mazen Asbahi McDonald Hopkins LLC Chicago, IL

Franklin D. Beahm Beahm & Green New Orleans, LA

Joseph Beemsterboer Assistant Chief of the Fraud Section, Criminal Division US Department of Justice Washington, DC

Scott Bennett Coppersmith Brockelman PLC Phoenix, AZ

Annapoorani Bhat Senior Manager, Consulting PYA Atlanta, GA

Amanda M. Brown Manager Veralon Partners New York, NY

Carolyn Buppert Law Office of Carolyn Buppert Portland, OR

Justin Burk Director HCA Physician Development Brentwood, TN

Michael R. Callahan Katten Muchin Rosenman LLP Chicago, IL

Gary L. Cantrell Deputy Inspector General for Investigations Office ofthe Inspector General US Department of Health and Human Services Washington, DC

Daniel O. Carroll Schenck Price Smith & King LLP Florham Park, NJ

Justin Chamblee Senior Vice President Coker Group Alpharetta, GA

Richard Y. Cheng DLA Piper LLP (US) Dallas, TX

Anthea R. Daniels Vice President and General Counsel Akron Children’s Hospital Akron, OH

Thomas E. Dutton Jones Day Columbus, OH

Andrea M. Ferrari Partner HealthCare Appraisers Inc Boca Raton, FL

John Fink Principal ECG Management Consultants San Diego, CA

Ellen M. Flynn Associate Vice President, Safety Vizient Chicago, IL

David M. Glaser Fredrikson & Byron PA Minneapolis, MN

Lisa M. Gora Wilentz Goldman & Spitzer PA Woodbridge, NJ

Adam H. Greene Davis Wright Tremaine LLP Washington, DC

Gerald M. Griffith Jones Day Chicago, IL

Nancy J. Griswold Chief Administrative Law Judge Office of Medicare Hearings and Appeals US Department of Health and Human Services Arlington, VA

Scott R. Grubman Chilivis Cochran Larkin Bever LLP Atlanta, GA

Jeanna Palmer Gunville Polsinelli PC Chicago, IL

Jennifer L. Gurevitz Vice President/Regional General Counsel CHRISTUS Health Irving, TX

Elizabeth R. Hammack Associate General Counsel University Hospitals Shaker Heights, OH

Matthew C. Hans Polsinelli PC Saint Louis, MO

Thomas H. Hawk King & Spalding LLP Atlanta, GA

Pamela E. Hepp Buchanan Ingersoll & Rooney PC Pittsburgh, PA

Tizgel K. S. High Vice President and Associate General Counsel LifePoint Health Brentwood, TN

Melissa Hill Deputy Assistant Director, Mergers IV Division Federal Trade Commission Washington, DC

Elizabeth F. Hodge Akerman LLP West Palm Beach, FL

David S. Holtzman Executive Advisor CynergisTek Inc Austin, TX

Robert G. Homchick Davis Wright Tremaine LLP Seattle, WA

Facu

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FacultyRachael A. Honig First Assistant U.S. Attorney US Attorney’s Office, District of New Jersey Newark, NJ

Thora A. Johnson Venable LLP Baltimore, MD

Matthew Josephson Assistant United States Attorney US Attorney’s Office, Southern District of Georgia Savannah, GA

Brian S. Kern Acadia Pro Morristown, NJ

Kristy M. Kimball Holland & Hart LLP Salt Lake City, UT

Adam Klein ECG Management Consultants San Diego, CA

Mark A. Knee Senior Policy Advisor Regulatory Affairs Division, Office of Policy Office of the National Coordinator for Health Information Technology US Department of Health and Human Services Washington, DC

Mark S. Kopson Plunkett Cooney Bloomfield Hills, MI

Marilyn Lamar Liss & Lamar PC Oak Brook, IL

Kim Harvey Looney Waller Lansden Dortch & Davis LLP Nashville, TN

Tony R. Maida McDermott Will & Emery LLP New York, NY

Brigid M. Maloney Lippes Mathias Wexler Friedman LLP Buffalo, NY

Patricia A. Markus Nelson Mullins Riley & Scarborough LLP Raleigh, NC

Richelle D. Marting Forbes Law Group LLC Overland Park, KS

Joseph Miller Mintz Levin Washington, DC

Haavi Morreim Professor, Department of Internal Medicine College of Medicine University of Tennessee Health Science Center Cordova, TN

Anna-Liisa Mullis Brownstein Hyatt Farber Schreck LLP Denver, CO

Karen Nelson DLA Piper LLP (US) Austin, TX

Gerard M. Nussbaum Zarach Associates LLC Chicago, IL

Antonia A. Peck Womble Bond Dickinson Durham, NC

Mindy Phillips Chief Corporate Officer SSM Health St. Louis, MO

Eric J. Plinke Dinsmore & Shohl LLP Columbus, OH

Michaela D. Poizner Baker Donelson Bearman Caldwell & Ber-kowitz PC Nashville, TN

James Max Reiboldt President/CEO Coker Group Alpharetta, GA

Erika Riethmiller Chief Privacy Officer, Senior Director Privacy Strategy University of Colorado Health Aurora, CO

Vicki L. Robinson Senior Counsel for Policy Office of the Inspector General US Department of Health and Human Services Washington, DC

Kim H. Roeder King & Spalding LLP Atlanta, GA

Kristen B. Rosati Coppersmith Brockelman PLC Phoenix, AZ

Andrew D. Ruskin Morgan Lewis & Bockius LLP Washington, DC

Jay Sanders PBC Advisors LLC Oak Brook, IL

Michael F. Schaff Wilentz Goldman & Spitzer PA Woodbridge, NJ

Jack S. Schroder Big Canoe, GA

Michael R. Schulze Sullivan Stolier Schulze and Grubb LLC New Orleans, LA

Daniel F. Shay Alice G Gosfield & Associates PC Philadelphia, PA

Patrick D. Souter Gray Reed & McGraw LLP Dallas, TX

Jessica E. Stack Senior Manager Veralon Partners New York, NY

Kim C. Stanger Holland & Hart LLP Boise, ID

Sadie Sullivan Corporate Counsel SCL Health Broomfield, CO

Andrew B. Wachler Wachler & Associates PC Royal Oak, MI

John R. Washlick Buchanan Ingersoll & Rooney PC Philadelphia, PA

Emily H. Wein Foley & Lardner Washington, DC

Scott A. Weinstein McDermott Will & Emery LLP Washington, DC

Paul H. Westfall Washington Counsel American Medical Association Washington, DC

Eric D. Whitman MD, Medical Director Atlantic Health System, Oncology Service Line Morristown, NJ

Stephanie D. Willis Crowell & Moring LLP Washington, DC

Lisa Ohrin Wilson Senior Technical Advisor Centers for Medicare & Medicaid Services Baltimore, MD

Brent Wilson University of Utah Compliance Department Bountiful, UT

Cynthia F. Wisner Associate Counsel Trinity Health Livonia, MI

Paul Wong NERA Economic Consulting San Francisco, CA

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

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

physicians and hospitals law institute february …...3 registration fees: postmarked and paid on or...

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