Certified Medical Compliance Officer

Practice Management

• Compliance structure and enforcements
• The seven elements of the compliance plan
• Health care fraud enforcement and sentencing guidelines
• False Claims Act, Stark, and the Federal Anti-Kickback Statute
• Calculation of civil monetary penalties
• Whistleblower complaints
• Legal provisions of compliance with a review of actual case examples
• Impact of Health Care Reform on enforcement statutes and practices
• Performing a gap analysis and other means of identifying practice-specific risks Billing/coding/coverage and reimbursement

Billing/coding/coverage and reimbursement

• Coding, billing and documentation considerations
• LCDs/NCDs and their applicability to coverage decisions
• Drafting and incorporating the office compliance plan
• Mission statement, codes of conduct, and organizational goals
• The growing threat of electronic security and identity theft Compliance, risks, actions and issues

Compliance, risks, actions, and issues

• Role of the Compliance Officer in the organizational hierarchy
• UPICs, ZPICs, RACs, SMERCs, and other Medicare/Medicaid contractors
• Correct handling of an audit request
• Organizational risks, peer review actions, state licensure issues
• Employee screening, staff, and patient relations
• Employee notification of obligations and consequences for failure to comply
• Drafting enforcement and discipline provisions
• Ongoing monitoring and auditing
• Overview of law enforcement organizations Medicare exclusion and its impact on an organization

Medicare exclusion and its impact on an organization

• Permissive vs. mandatory exclusion
• Co-payments, waivers, deductibles, and write-offs
• Overpayments, federal Anti-Kickback, False Claims Act, and Stark implications
• Gratuities, kickbacks, and payments to physicians
• Types of referrals that may violate one or more federal statutes
• Business relationships between your practice/clinic and other providers
• Setting up mechanisms for employees to file anonymous complaints
• Avoiding allegations of reprisal and responding to identified deficiencies
• Voluntary repayments - advantages and disadvantages of making repayment Law enforcement investigation tools

Law enforcement investigation tools

• Subpoenas and search warrants and how to respond to compulsory process
• Employment of consultants, lawyers, and other third-party advisors
• Federal and non-federal administrative appeals of denied claims
• HIPAA/HITECH and the relationship between privacy and compliance
• Business associate pitfalls to consider
• Future risks to your organization

Robert W. Liles, JD, MBA, MS

Robert W. Liles was the first National Health Care Fraud Coordinator and subsequently worked as Deputy Director of the U.S. Department of Justice, Executive Office for United States Attorneys. As Managing Member in the Washington D.C. based office of Liles Parker, PLLC, Robert heads one of the nation’s leading law firms focused on health care fraud defense and regulatory matters representing providers in civil, criminal, and administrative proceedings. Robert’s background, education, and experience bring this class to life with a real-world perspective.

D.K. Everitt, CMCO, CCO

D.K. Everitt is a certified medical compliance officer with over thirty years experience in practice management, the development and management of medium to large medical facilities, and the development, implementation, and maintenance of corporate compliance programs. He serves as Chief Healthcare Compliance Officer and President of The Compliance Division, L.L.C.

• The CMCO is geared towards non-hospital healthcare professionals.
• Experience working in a medical office is recommended for this course.
• Candidates for CMCO certification must demonstrate competency by proctored examination.