Agenda

Date and TimeTitle
Sep 13, 2021
10:00am - 11:00am (Eastern)
Breakfast with Sponsors!

Grab your morning coffee and breakfast and come join us in the Breakfast Lounge!

As you navigate and spend time at the conference, join fellow attendees in our Giveaway Challenge!

Check the Leader Board to see where you rank in the challenge!

Sep 13, 2021
11:00am - 11:57am (Eastern)
State Regional Roundtables - **State Only**

This session is an opportunity for State attendees to discuss problems, solutions, and more with others in their region.

 

-Led by the Regional Representatives

Sep 13, 2021
12:00pm - 12:05pm (Eastern)
Opening Remarks & Welcome by NAMPI Board
Sep 13, 2021
12:05pm - 12:50pm (Eastern)
Keynote Address: Dan Cnossen - Sponsored by KPMG

Dan Cnossen, US Navy Seal, 6-Time Paralympic Medalist, and 2-Time Paralympian
Moderated by: Joseph Cassano, KPMG

Sponsored by KPMG

 

Sep 13, 2021
12:55pm - 1:40pm (Eastern)
Plenary Session: Healthcare Fraud Trends

After a brief overview of the components within the OIG, this presentation will cover various persistent and emerging healthcare fraud trends

 

Sep 13, 2021
1:45pm - 2:15pm (Eastern)
Networking Break with Sponsors! - Sponsored by Optum

Networking with Sponsors in the Exhibit Hall

Sponsored by Optum

Sep 13, 2021
2:20pm - 3:05pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 1: Y-PIC the UPIC

Panel discussion regarding different perspectives and experiences working with CMS' Unified Program Integrity Contractors for Medicaid audits and investigations. The panel will consist of states that are at different stages of their UPIC partnership. Topics of discussion will include challenges we've faced and related solutions, successful outcomes, and advantages of partnering with a UPIC.

Sep 13, 2021
2:20pm - 3:05pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 1: Interviewing in a Pandemic World

Flexibility is the name of the game as we move forward. Let's explore methods to gather information in new ways. Discover new skills and dust off some old ones to succeed in this ever-changing environment.

Sep 13, 2021
2:20pm - 3:05pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 1: State Best Practices and Upcoming State Reviews

The purpose of this session is to provide an overview of the Center for Program Integrity's Medicaid promising practice. You will gain insight on the background, purpose, schedule and where promising practices are published. This session will also include information on the Medicaid Program Integrity Review process. You will gain insight on the types of reviews performed, common findings, as well as the 2022 schedule.

Sep 13, 2021
3:10pm - 3:55pm (Eastern)
VENDOR BREAKOUT BLOCK 1: Risks Around Pharmacy Program Integrity

Overview of recent legislative and legal developments related to pharmacy benefit spend. How have these actions changed the conversation around risk and responsibility for overpayments in pharmacy benefit spending? What are the domains where states bear the risk of overpayment in their programs (spoiler: it goes beyond spread pricing)? What are the historical limitations to effective program integrity around this benefit, and what tools are available to states to break through those limitations? What steps can states do to properly identify and mitigate the risks specific to their program?

Sep 13, 2021
3:10pm - 3:55pm (Eastern)
VENDOR BREAKOUT BLOCK 1: Advanced Analytic Models: Wondering Where to Start?

The domain of advanced analytics, AI and machine learning can seem intimidating and confusing to venture into for many PI units. Yet with the continuing advances in these technologies, organizations want to leverage them to help scale FWA identification and provide insights that go beyond traditional policy and "known" scheme-based algorithms. Our Watson Health Subject Matter Experts will offer some practical advice on how to take your first steps into this advanced analytics space.

Sep 13, 2021
3:10pm - 3:55pm (Eastern)
VENDOR BREAKOUT BLOCK 1: Going Beyond Claims: Integrating Non-Traditional Data and Methods to Advance State Medicaid Program Integrity

COVID-19 brought unprecedented disruption to State Medicaid programs – everything from new eligibility policies to supply chain challenges and extraordinary increases in telemedicine use.
Accordingly, program integrity units are faced with a “new normal” where legacy tools and methods may be falling short of identifying sophisticated and complex fraud schemes. To achieve a “pro-people, anti-fraud” mission, Medicaid agencies need comprehensive data insights, combined with next-generation analytic tools, machine learning, and program expertise to make actionable decisions.

Sep 13, 2021
3:10pm - 3:55pm (Eastern)
VENDOR BREAKOUT BLOCK 1: Preparing For The Second “Waive” of COVID: Anticipating FWA From PHE-driven Waivers and Funding

With the COVID-19 pandemic providing opportunities for additional funding, this session will address areas susceptible to improper payments and potential FWA based on waivers approved during the PHE, as well as readiness for reviews of CARES Act funding. In addition to presenting data and approaches for states to consider, KPMG will share its perspective on the outlook for states based on guidance from oversight bodies, such as GAO and OIG/MFCUs.

Sep 13, 2021
3:55pm - 4:15pm (Eastern)
Afternoon Coffee Break with Sponsors - Sponsored by Optum

Networking with Sponsors in the Exhibit Hall

Sponsored by Optum

Sep 13, 2021
4:15pm - 5:00pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 2: Collaboration to Oversight: A State Perspective on Managed Care PI

This course will be a round table with four states related to their perspectives on Program Integrity in Managed Care. The presenters will open with a background of managed care in California, Florida, North Carolina and Oregon, then will have a discussion related to topics such as fraud and abuse referrals, managed care contracts, recoveries, PI units oversight activities, working with SIUs and other partners and reporting.

Sep 13, 2021
4:15pm - 5:00pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 2: 2021 Updates and Changes in Medical Coding

In this session, we will review the Evaluation and Management changes for 2021. We will also review some of the ICD-10 CM and PCS as well as the October Quarterly release. What coding changes are on the horizon related to our guidelines in Evaluation and Management.

Sep 13, 2021
4:15pm - 5:00pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 2: The HFPP and Medicaid: Making it Work For You

CMS, the Healthcare Fraud Prevention Partnership's (HFPP) Trusted Third Party and the State of Oregon will discuss the HFPP. What's in it for the states and how the states can get the most out of it.

Sep 13, 2021
5:00pm - 6:15pm (Eastern)
Give Back Game Night: Live Evening Networking Event! - Sponsored by HMS, A Gainwell Technologies Company

Sponsored by HMS, A Gainwell Technologies Company

Sep 14, 2021
10:00am - 11:00am (Eastern)
Breakfast with Sponsors!

Grab your morning coffee and breakfast and come join us in the Breakfast Lounge!

As you navigate and spend time at the conference, join fellow attendees in our Giveaway Challenge!

Check the Leader Board to see where you rank in the challenge!

Sep 14, 2021
11:00am - 11:06am (Eastern)
Opening of Day 2 with the Box Trip
Sep 14, 2021
11:00am - 11:48am (Eastern)
Plenary Session: CPI Update, MII Update, Fraud Trends​

The purpose of this session is to provide an overview of the Center for Program Integrity organizational changes and highlights of accomplishments within the past year.

Sep 14, 2021
11:50am - 12:35pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 3: OIG’s Exclusion Authorities: A Primer and a Case Study

An overview of OIG's permissive and mandatory exclusion authorities and a case study of the OIG's exclusion of a nursing home provider.

Sep 14, 2021
11:50am - 12:35pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 3: Major Case Coordination: A Federal Perspective

Coordinating fraud referrals as well as the related administrative actions between administrative agencies and law enforcement comes with a number of challenges such as ensuring proper coordination and accountability. To address these challenges, CMS and HHS-OIG established a Major Case Coordination (MCC) initiative for Medicare fraud referrals that includes stakeholders from the HHS-OIG, DOJ, and CMS that provides an opportunity for Medicare and Medicaid policy experts, law enforcement officials, clinicians, and fraud investigators to collaborate before, during, and after the development of fraud leads. This level of collaboration has contributed to several successful coordinated law enforcement actions and helped CMS to better identify national fraud trends and program vulnerabilities. The MCC has led to an increase in the number and quality of law enforcement referrals as well as an increase in the number of CMS administrative actions. CMS and HHS-OIG will share their experiences in establishing the Medicare Major Case Coordination process that SMAs and MFCUs can learn from. Also, CMS and the Louisiana Dept. of Health will share their experience in establishing a similar process related to Medicaid UPIC investigations.

Sep 14, 2021
11:50am - 12:35pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 3: Case Study: Adoption Scheme

Case study of an adoption scheme involving an elected official committing Medicaid fraud. Pregnant women were brought into the USA, placed on Medicaid, adopted children out, and women sent to another state and/or out of the USA.

Sep 14, 2021
12:35pm - 1:00pm (Eastern)
Networking Break with Sponsors! - Sponsored by Optum

Networking Break with Sponsors in the Exhibit Hall

Sponsored by Optum

Sep 14, 2021
1:00pm - 1:45pm (Eastern)
VENDOR BREAKOUT BLOCK 2: Tangible Take-Aways: Tackling Long-Term Care Audits with North Dakota

Long-term care abuse is a massive part of the payment integrity challenge. With studies projecting over $8 Billion in long-term care FWA this year alone, payers need new ways to get ahead of the problem. Join us for an impactful session where you’ll hear directly from Dawn Mock, North Dakota’s Program Integrity Administrator, as she shares her real-world experience tackling long-term care audits.

Dawn will share practical advice for payers looking to:
- Tackle long-term care challenges
- Identify and quantify a systematic solution
- Take effective action
- Reduce provider abrasion
- Monitor behavior consistently

You’ll walk away with actionable ideas and best practices to put right to use for your payment integrity program. See you at the session!

Sep 14, 2021
1:00pm - 1:45pm (Eastern)
VENDOR BREAKOUT BLOCK 2: The Globalization of Fraud – International Organized Crime and Healthcare Fraud

Organized criminal networks are infiltrating our public benefit programs at growing rates. Meanwhile, we are still fighting to keep pace with larger than ever attempted and executed fraud rates post-pandemic. During this session, participants will hear from Jeffrey Robinson, one of the world’s leading experts on international financial crime. He is the bestselling author of over 30 books including “The Laundrymen.” Mr. Robinson will share his perspectives on how international criminal networks are leveraging cutting-edge technology and the internet to commit healthcare fraud and related financial crimes.

Thomson Reuters and Pondera are passionate about understanding the underlying schemes and criminal networks that perpetrate fraud in government programs and are thrilled to bring this expert speaker to NAMPI 2021.

Learn more about understanding the nature of fraud and international criminal networks, how modern technology and the internet supports their endeavors, how and why we are seeing an increase in international network-driven fraud in healthcare, and what can Medicaid programs do to mitigate this risk.

Sep 14, 2021
1:00pm - 1:45pm (Eastern)
VENDOR BREAKOUT BLOCK 2: Using Machine Learning and Social Media Monitoring to Identify Drug Diversion and COVID Schemes




During this session, we will discuss a drug diversion case and a COVID-19 case where we leveraged machine learning, risk scoring, and social media risk monitoring to identify providers perpetrating fraud, waste, and abuse (FWA.) We will discuss investigative and analytic techniques that include monitoring of digital and social media platforms to assist in flagging conversations related to potential FWA. Using these methods, our team supported the Appalachian Regional Prescription Opioid Strike Force in the largest single enforcement action against medical professionals in U.S. history. Using social media, our investigators have made numerous referrals to HHS OIG and CMS.

Moderator: Amina Popowich, Deloitte

Sep 14, 2021
1:55pm - 2:40pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 4: Loopholes Resulting From COVID-19 EVV and Behavioral Health

This session will focus on identifying loopholes in billing and coding creating compliance issues with COVID-19 testing EVV and behavioral health.

Sep 14, 2021
1:55pm - 2:40pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 4: A Discussion of Health Care Fraud and Abuse Trends with the FBI and HHS-OIG

• Information from the FBI and HHS-OIG on fraud and abuse trends
• Information on DOJ, HHS-OIG, and the FBI annual reporting, such as the HCFAC report
• Questions and other interactions with NAMPI members on trends and the identification of schemes.

Sep 14, 2021
1:55pm - 2:40pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 4: Foundational Health Care Fraud Laws

Everyone participating in this conference already knows that health care fraud is a significant drain on health care resources. Understanding the law, even if you aren’t a lawyer who prosecutes health care fraud cases, understanding the basics of key health care fraud laws will help you identify better cases for investigation and referral.

Sep 14, 2021
2:40pm - 3:10pm (Eastern)
Afternoon Coffee Break with Sponsors - Sponsored by Optum

Networking with Sponsors in the Exhibit Hall

Sponsored by Optum

Sep 14, 2021
3:10pm - 4:00pm (Eastern)
VENDOR BREAKOUT BLOCK 3: Small SIU Team Found AI-Driven Technology Met Scalability Needs

Driscoll Health Plan sought to scale their SIU and complement their current fraud detection processes, they found that Artificial Intelligence (AI) could be an invaluable tool in identifying potential areas of fraud, waste and abuse and allow for rapid, effective mitigation. An AI-based solution was the perfect complement to the Investigative Analyst’s toolkit, instincts and knowledge. Outliers were easily validated without the common excess investigative efforts and loss of time resulting from false positives. Driscoll’s Investigative staff collaborates closely with other DHP Departments including Provider Relations, Credentialing and Contracting and Claims and the AI technology helps cement DHP’s investigative process.

Key Objectives of Session:
- Learn how AI can help SIU and investigation teams scale while achieving greater efficiency?
- Hear how DHP’s SIU team has contributed to the mitigation of fraud, waste and abuse through tight collaboration with their pharmacy department and the ability to identify outlier provider behavior

Sep 14, 2021
3:10pm - 4:00pm (Eastern)
VENDOR BREAKOUT BLOCK 3: Prescription for Program Integrity: Identifying Fraud, Waste and Abuse in PBMs and MCO-delegated Vendors

PBM overpayments, spread pricing, and other vendor fraud, waste and abuse issues have made national headlines lately. This session will help you understand the risks associated with these vendors in your MCO program and discuss some oversight tools and techniques that will support the oversight required within the MCO final rule.

Sep 14, 2021
3:10pm - 4:00pm (Eastern)
VENDOR BREAKOUT BLOCK 3: Identity Theft: Who’s Who in Health Care

Join us to discuss the emerging challenges in combatting and preventing Identity Theft in Health Care. This panel conversation will dive into the current health care fraud landscape and present analytical strategies for recognizing false identities and preventing ID Fraud.

Topics include:


• Medicaid ID Theft
• Synthetic Identity & Newborn SSN Theft
• Home Health Employee Credential Theft
• Prescription Pad Theft

Sep 14, 2021
4:05pm - 4:50pm (Eastern)
The Time is Now: Maximize Your Program Integrity

As we emerge from the recent COVID-19 pandemic, challenges continue to multiply – and complicate – the healthcare ecosystem. For example, more enrollees have joined Medicaid programs, healthcare spending continues to rise and new COVID-related fraud schemes have emerged as added threats. In light of these challenges, the time is now to re-evaluate how well your Program Integrity (PI) efforts drive real-world value and support the entire healthcare continuum.

Moderator: John Oswald, HMS, A Gainwell Technologies Company

Sep 14, 2021
5:00pm - 6:00pm (Eastern)
unWINEd: Live Evening Networking Event! - Sponsored by Deloitte

Sponsored by Deloitte

Sep 15, 2021
10:00am - 11:00am (Eastern)
Breakfast with Sponsors!

Welcome to the final day of NAMPI Virtual 2021!

Grab your morning coffee and breakfast and come join us in the Breakfast Lounge!

Today's the last chance to play and win the NAMPI 2021 Giveaway Challenge!

Check the Leader Board to see where you rank!

Sep 15, 2021
11:00am - 11:45am (Eastern)
Collaboration Between Units: MFCU & PI Director Panel Discussion
Sep 15, 2021
11:50am - 12:35pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 5: Navigating the Challenges of CMS Approval and Certification of Enhanced Federal Funding for Automated Data Processing Projects

This session will be an overview of the major steps required to be completed by a state Program Integrity Unit that desires to receive enhanced federal funding for the implementation and operation of a new Information Technology solution. The session will primarily concentrate on the Advanced Planning Documents required to be submitted to CMS and the new Outcomes-Based Certification process.

Sep 15, 2021
11:50am - 12:35pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 5: Intermediate Care Facility Fraud Scheme

$11 million fraud scheme involving the CEO and CFO of Hacienda Healthcare in Phoenix, AZ.

Sep 15, 2021
11:50am - 12:35pm (Eastern)
STATE/FEDERAL BREAKOUT BLOCK 5: Litigating Managed Care Issues: The Case of South Bay Mental Health Center

This session will discuss the South Bay Mental Health Center litigation, which has been handled by the Massachusetts Attorney General's Office and whistleblower counsel. This case involves allegations of unlicensed supervision of mental health clinicians at South Bay's clinics. The presentation will discuss the many important holdings in the Court's recent summary judgment decision, including the role of decisions by program integrity officials and managed care entities.

Sep 15, 2021
12:35pm - 1:00pm (Eastern)
Cooking with Kelly 2021!
Sep 15, 2021
1:10pm - 2:00pm (Eastern)
Conversations with States: Hot Topics 2021

Moderator: Anne Harvey, Nebraska Department of Health & Human Services