2016 AHIA REGIONAL · This presentation will provide an overview of the audit process, a look back at the Phase II audit period, and provide practical solutions and best practices

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FULL CONFERENCE REGISTRATION: Early-Bird Price - $350After Nov. 8, 2016 - $375

ONE-DAY REGISTRATION:Wednesday, Nov. 30 - $175Thursday, Dec. 1 - $200Friday, Dec. 2 - $175

Annually, The New England Healthcare Internal Auditors (NEHIA) hosts its primary educational conference bringing expert presenters from healthcare compliance, privacy, security, and of course, internal auditing to one conference. Each presentation is an opportunity for presenters to share their knowledge with all levels of conference attendees and for conference attendees to listen and learn best practices from some of the industry’s best. In addition to providing low cost, high quality educational sessions, NEHIA works diligently to connect conference members with each other to create a strong community of healthcare professionals in New England.

AHIA is proud to partner with NEHIA since 2015 and provide support for its annual conference, bringing more education and resources to internal auditors and healthcare professionals of New England.

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3:15 - 4:15 pm - OCR Audits Phase 2 with real life experience - how to navigate William Roberts, Associate, Chair of Privacy and Data Protection Group, Shipman & Goodwin LLP

In March of 2016, the United States Department of Health and Human Services Office for Civil Rights (“OCR”) launched “Phase II” of its HIPAA compliance audit program. The purpose of these audits is to assess compliance with the HIPAA Privacy, Security and Breach Notification Rules and both covered entities and business associates may be subject to them. While these audits are primarily desk audits, some on-site audits are being conducted.

This presentation will provide an overview of the audit process, a look back at the Phase II audit period, and provide practical solutions and best practices for preparing for and handling an OCR HIPAA audit. The presentation will also consider how to interact with OCR and the implications an audit may have for a health care organization.

Field of Study: Auditing CPE: 1 Level: All

4:15 - 5:15 pm - Health Care Data Analytics: Fraud Detection and AuditsMichael Salve, Senior Managing Director, FTI; Robert Fruite, Managing Director, FTI

Network analysis is visualizing and evaluating relationships and flows among people, groups, organizations, doctors, patients and providers. In healthcare fraud cases, we will assist clients with advanced fraud detection methods (network analysis and predictive analytics) that target root causes of fraud and then design statistical samples for the compliance team to review. After the compliance department review is complete, we assist with the statistical extrapolation of the results to the broader claim population.


Conference LocationMystic Marriott

625 North Road (Route 117)Groton, CT 06340

(860) 446-2600

Register Online at www.ahia.org

Schedule of Events9:00 am Registration

10:00 - 11:00 am - Closing the Loop: Preventing Loss from Returned GoodsMichael Nisivoccia, Project Manager, The Audit Group

Implantable medical devices are an estimated $50 billion market in the US, a figure that will only see growth in the years to come. With increased regulatory pressure, competition in both the for-profit and non-profit sectors, and the trend toward strategic acquisitions/partnerships, health providers nationwide are forced to adapt or perish.

At The Audit Group, one of the largest issues our recovery audits identify is the lack of proper controls when tracking returned goods. The reasons behind the struggle are multi-faceted: Returning product requires communication and coordination between multiple departments and, in some cases, physical locations; the formal Returned Goods Process is non-existent or poorly explained to those involved; ERP tracking tools are not utilized; and no follow up is done to ensure the vendor credits the hospital account. Closing the Loop: Preventing Loss from Returned Goods will address the common vulnerabilities and weaknesses we’ve identified and highlight how a successful program functions. Field of Study: Auditing CPE: 1 Level: All

11:00 - 12:00 pm - Auditing the Revenue Cycle Andy Adams, Partner, E&Y; Dave Dreher, Partner, E&Y

• Discuss types of risk in the revenue cycle• Transform revenue cycle management• Advance analytical techniques• Optimize the technology environment


12:00 - 1:00 pm LUNCH

1:00 - 2:00 pm - The Current Enforcement Environment in the SNF Arena Joel Dziengielewski, Director, Navigant Consulting

The presentation will focus on the current enforcement environment in the SNF sector. The discussion will address key risk areas, operational areas that bring risk and what participants can do to mitigate such risks. Participants will learn of recent actual cases highlighting pitfalls and outcomes of inferior compliance practices, as well as leading practices to mitigate risk areas.


2:00 - 3:00 pm - Experiences with Provider Credentialing: Risk Areas & Improvement Opportunities Molly Hinchey, Corporate Compliance and Program Integrity Manager, North Shore Medical Center

This modified case study highlights the importance of examining non-quantitative areas like medical personnel files, an area not typically residing at the top of most audit plans. Dated systems, variations in credentialing processes, and multifaceted applications complicate this auditing task, while national boards, federal background checks and complex approval bodies feign perfection amongst these types of personnel files. Allow our recent experience with provider credentialing files to be a lesson in the importance of monitoring medical staff files on a more regular and thorough basis, even when tight processes are in place.


3:00 - 3:15 pm BREAK

Wednesday, November 30, 2016

Thursday, December 1, 2016

Schedule of Events7:30 - 8:30 am Breakfast / Registration

8:30 - 9:30 am - Hot Topics in Compliance: the 60 Day Final Rule and Other Current Issues Lourdes Martinez, Partner, Garfunkle, Wild & Travis

Among the many components of the 2010 Affordable Care Act (“ACA”) was a change in Federal law requiring Medicare and Medicaid providers to report, return and explain overpayments within 60 days of identification of the overpayment. Six year later, the Centers for Medicare and Medicaid Services (“CMS”) adopted a Final Rule implementing this requirement.

This session will discuss that Final Rule, including CMS’s prospective on what constitutes an overpayment, what compliance activities CMS expects health care provider’s to implement to prevent and detect overpayments, and the potential liabilities for non-compliance with this aspect of the ACA. This session will also focus on the latest developments related to compliance with the Federal fraud and abuse laws, including the U.S. Supreme Court’s recent decision validating the theory of “implied certification” in False Claims Act cases, the huge increase in False Claims Act penalties and other emerging compliance issues.


9:30 - 9:45 am BREAK 9:45 - 10:45 am - Demystifying IS Risk Assessments Michael Kanarellis, IT Assurance Sr. Manager, Wolf and Company

The regulatory landscape in healthcare continues to evolve and become more complex, while the punitive damages for HIPAA noncompliance also continue to grow. One of the core tenets of the HIPAA Security Rule and Meaningful Use is that a risk assessment be performed to properly gauge key risk factors and to assess that security controls surround the administrative, technical, and physical safeguards of both paper and electronic health records. However, what constitutes a risk assessment remains a point of confusion for many healthcare providers, physician practices, and business associates.

Michael Kanarellis, Director of Healthcare Security for Wolf & Co, will discuss the differences between a HIPAA/NIST security gap analysis and a true Risk Assessment and how one can inform the other. Michael will also discuss the key components that need to be in every healthcare organizations information security program such as Network Security Reviews, Penetration testing, and Social Engineering testing. The Office of Civil Rights (OCR) continues to be more aggressive with punitive action for HIPAA noncompliance. Based on Michael’s experience with the OCR he will discuss what to expect if you suffer a breach or are selected for an OCR HIPAA audit.


10:45 - 11:00 am BREAK

11:00 - 12:00 pm - EMR Implementation Compliance Roles Stephen Gillis, Director, Billing Compliance, Partners HealthCare

Compliance departments are often kept out of the loop during clinical and financial system implementations, only to be called in after the fact to help clean up coding, documentation and billing mishaps. The intent of the break out session is to identify options pertaining to when and how compliance professionals can integrate their routine monitoring and auditing activities into go-live preparation, assessment and monitoring , both pre and post go-live. The use of data analytics will be highlighted as one of the most effective and efficient means to monitor a system go live.


11:00 - 12:00 pm - NP/PA BillingMaseQua Pina, Associate Compliance Officer, System Audits, Yale New Haven Health

The intent of the break out session is to clarify “incident to” services billed by physicians and non-physician practitioners to carriers. “Incident to” services are defined as those services that are furnished incident to physician professional services in the physician’s office (whether located in a separate office suite or within an institution) or in a patient’s home.

These services are billed as Part B services to your carrier as if you personally provided them, and are paid under the physician fee schedule. “Incident to” services are also relevant to services supervised by certain non-physician practitioners such as physician assistants, nurse practitioners, clinical nurse specialists, nurse midwives, or clinical psychologists. These services are subject to the same requirements as physician-supervised services. Remember that “incident services” supervised by non-physician practitioners are reimbursed at 85 percent of the physician fee schedule.


12:00 - 1:00 LUNCH

1:00 - 2:00 pm - Top Ten Risks in Home Health Care- Mitigate Your Exposure June Crawford, Principal, Bonadio Group

Two factors should drive internal audit and compliance program activities for Home Health Agencies (HHA): heightened scrutiny of HHA claims for improper payments due to fraud and abuse, and the Affordable Care Act’s requirement for the return of overpayments within 60 days of identification. The presenter will address the top ten risks in HHA services based on recent audit activities, governmental investigations, and her experience conducting risk assessments and record audits of HHA provider agencies. Attendees will leave the session with practical approaches to risk assessment and internal audit activity. Field of Study: Auditing CPE: 1 Level: All

2:00 - 3:40 pm - Primer and Case Scenarios: The Practical Application of Stark Law and the Anti-Kickback Statute Prohibitions Christine Savage, Partner, Choate, Hall & Stewart, LLP

This presentation will provide attendees with an overview/refresher of the most commonly implicated Stark and Anti-kickback provisions, as well as case scenarios that often present in a health care provider setting.


3:40 - 3:50 pm BREAK

3:50 - 5:30 pm - The Role of Compliance in Due Diligence in Hospital Acquisitions Rebecca Matthews, Partner, Wiggin & Dana; Donna Schneider, System Revenue Compliance Officer, Yale-New Haven Health System

We will review various affiliation structures and due diligence concerns in each. Focus will be on the scope and purpose of due diligence, how due diligence relates to contractual obligations in an affiliation or other agreement, and what parties to an affiliation should do when problems or issues are uncovered. We will also discuss/cover the role of compliance and internal audit in diligence.


5:30 - 6:30 pm NETWORKiNG RECEPTION


Friday, December 2, 2016

Schedule of Events7:00 - 8:30 am Breakfast / Registration

8:30 - 9:30 am - Drug Diversion: Enforcement Trends, Prevention and EnforcementDavid Yarin, Director, Deloitte

The presentation will cover drug diversion enforcement trends, detection, investigation and prevention best practices, focusing on the role of the internal auditor with respect to these focus areas. The presentation will also include examples of industry best practices and illustrative stories to highlight the impact of drug diversion and best practices for prevention, detection and investigation.


9:30 - 10:30 am - NP/PA BillingMaseQua Pina, Associate Compliance Officer, System Audits, Yale New Haven Health

The intent of the break out session is to clarify “incident to” services billed by physicians and non-physician practitioners to carriers. “Incident to” services are defined as those services that are furnished incident to physician professional services in the physician’s office (whether located in a separate office suite or within an institution) or in a patient’s home.

These services are billed as Part B services to your carrier as if you personally provided them, and are paid under the physician fee schedule. “Incident to” services are also relevant to services supervised by certain non-physician practitioners such as physician assistants, nurse practitioners, clinical nurse specialists, nurse midwives, or clinical psychologists. These services are subject to the same requirements as physician-supervised services. Remember that “incident services” supervised by non-physician practitioners are reimbursed at 85 percent of the physician fee schedule.


9:30 - 10:30 am - EMR Implementation Compliance Roles Stephen Gillis, Director, Billing Compliance, Partners HealthCare

Compliance departments are often kept out of the loop during clinical and financial system implementations, only to be called in after the fact to help clean up coding, documentation and billing mishaps. The intent of the break out session is to identify options pertaining to when and how compliance professionals can integrate their routine monitoring and auditing activities into go-live preparation, assessment and monitoring , both pre and post go-live. The use of data analytics will be highlighted as one of the most effective and efficient means to monitor a system go live.


10:30 - 10:45 am BREAK

10:45 - 11:45 am - Getting Ahead of MACRA and its ImplicationsHeather Hagan, Director, Deloitte

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) fundamentally changes how Medicare payments to health care professionals will be updated in the future and puts significant revenue at stake for hospitals that employ health care professionals. The law’s incentives for entering into risk-bearing coordinated care models could set the stage for other payers. Health care providers will need to examine their participation in risk-bearing coordinated care models and assess their capabilities to adapt to new measures for quality of care and performance.


11:45 - 12:00 pm BREAK

12:00 - 1:00 pm - Healthcare Facilities / Capital Planning and Delivery Adam Bruhnke, Manager, PwC; Manuele Vincent, Director, PwC

As healthcare organizations enter a period of rapid growth and increasing demands on existing capital infrastructure, many are embarking on planning and delivering significant capital programs. As they do so, they are confronted with increasing programmatic risks and often daunting challenges in achieving cost, schedule, and quality performance goals. In our session, we will discuss capital planning considerations and effective capital program delivery strategies.

Topics will include governance, executive oversight, program delivery framework, contracting structure and pricing, organizational effectiveness, risk identification and management, procurement and sourcing, contract and scope management, cost and schedule controls, performance metrics, and communication & reporting. In addition, we will present some of the ways that Internal Audit can partner with key decision-makers to mitigate the risks that are inherent in the capital planning and delivery process.


Conference Location

Mystic Marriott625 North Road (Route 117)

Groton, CT 06340(860) 446-2600


Full Conference: h Early-Bird Price $350h After Nov. 8, 2016 $375

One-Day Passes:

h Wednesday Only $175h Thursday Only $200h Friday Only $175

One registration form per attendee. Copy this form as needed.

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Conference Location

Mystic Marriott625 North Road (Route 117)

Groton, CT 06340(860) 446-2600

Special Conference Rate: $91 per nightReservation Deadline: November 8, 2016

Continuing Professional Education Credits

AHIA is registered with the National Association of State Boards of Accountancy 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 credits. Complaints regarding registered sponsors may be addressed to the National Registry of CPE Sponsors, 150 Fourth Avenue North, Suite 700, Nashville TN, 37219-2417; 615.880.4200; http://www.nasba.org. In accordance with the standards of the National Registry of CPE Sponsors, CPOE credits have been granted based on a 50-minute hour. National Registry of CPE Sponsors ID Number 103386

A maximum of 18.0 CPE credits will be granted

The Compliance Certification Board (CCB)® has approved this event for up to 21.6 CCB CEUs. Continuing Education Units are awarded based on individual attendance records. Granting of prior approval in no way constitutes endorsement by CCB of this program content or of the program sponsor.

Full Conference: Early-Bird Price $350 After Nov. 8, 2016 $375

One-Day Passes:

Wednesday Only $175 Thursday Only $200 Friday Only $175

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Cancellations & SubstitutionsNo refunds will be given for “no shows. ” Cancellations received in writing by November 18, 2016 will be issued a refund less a $50 cancellation fee. NO REFUNDS FOR CANCELLATIONS AFTER November 18, 2016. AHIA/NEHIA reserves the right to cancel any event due to insufficient registration or any unforeseen circumstances. In the unlikely event of cancellation, AHIA/NEHIA are not responsible for any costs, damages, or other expenses of any kind, including, without limitation, transportation and/or hotel costs incurred by registrant. Speakers are subject to change without notice. You may send a substitute; please call AHIA at 888-275-2442.

Regional Seminar Fees

Return this form with payment to: 10200 West 44th Avenue, Suite 304

Wheat Ridge, CO 80033Phone: 888.275.2442 l Fax: 720.881.6101


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Registration Form

CCB APPROVED FOR

CCB CREDIT(s)Compliance Certi�cation Board

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William Roberts is a member of Shipman & Goodwin LLP’s Health Law Practice Group and is the Chair of the firm’s Privacy and Data Protection group. Bill focuses his practice on health care corporate, regulatory, data privacy and compliance matters. He represents hospitals and health systems; physician group practices; health insurance companies; behavioral health providers; federally qualified health centers; medical device and pharmaceutical companies and a variety of other public and private sector clients.

As Chair of the firm’s Data Privacy and Security Client Team, Bill routinely advises clients on data privacy and security laws, particularly as those laws intersect with the health care industry. He prepares comprehensive privacy and data security programs and policies for businesses, and regularly counsels clients regarding the collection, use, retention, disclosure, transfer and disposal of protected health information and personal information. Bill has assisted clients navigate and remediate over 150 data breaches.

Michael Salve and Robert Fuite have applied social network analysis and graph theory in fraud detection. These innovative techniques have revealed unexpected, yet systematic, relationships among physicians and other providers with respect to their common billing and claim submission patterns.

Michael and Robert are applied economists with experience in advanced quantitative methods, statistical studies, healthcare claims sampling, False Claims Act matters, econometric modeling, ZPIC audits, network analysis and commercial disputes.

Lourdes M. Martinez is a Partner/Director at Garfunkel Wild, P.C., which she joined in 1998. She is a Co-Chair of the firm’s Compliance and White Collar Defense, and a member of the HIPAA Compliance and Health Care Practice Groups.

Ms. Martinez’s practice includes: defending clients in criminal, civil and regulatory government actions; assisting clients in implementing both fraud and abuse and HIPAA compliance programs; and advising clients on a wide array of compliance, regulatory and business matters. Ms. Martinez has defended clients in Federal False Claims Act cases, quality of care cases, physician licensing matters and Federal, state and other third-party audits.

Ms. Martinez frequently writes and lectures on regulatory defense and compliance issues. Her published works include articles written for the New York Health Law Update and the New York State Bar Association’s Health Law Journal.

Michael Kanarellis’s experience consists of over 20 years of properly scoping security/compliance/audit initiatives for organizations across all verticals with particular expertise in healthcare and managing those efforts. Michael has been involved in the managing of projects which include; IT risk management & assessments, vendor management reviews, social engineering, wireless network security, web applications, firewalls, general information security & controls, IT governance, business continuity planning, vulnerability/penetration testing, and various application security reviews. Michael has also been involved with Office of Civil Rights (OCR) corrective action plan (CAP) audits. In addition to technical audits noted above, Michael has performed work in various compliance areas including Health Insurance Portability and Accountability Act,(HIPAA), NIST 800-53, 800-30, 800-66, The HITECH ACT, Meaningful Use risk assessments, ISO 27001, PCI-DSS 3.2, and other state privacy laws.

June Crawford is a Principal in the Compliance Solutions Division at The Bonadio Group. She is a Registered Professional Nurse with more than 25 years of supervisory experience. She has held the positions of Director of Nursing Services, Director of Residential Services, Director of Continuous Improvement, Corporate Compliance Officer and HIPAA Privacy Officer.

Michael Nisivoccia is a Project Manager at TAG with over 6 years’ experience auditing and consulting with Healthcare Systems in the northeast, including Yale New Haven Health, about their Supply Chain and P2P practices and procedures. During that time, I have partnered with Materials Management and Accounts Payable departments, recovering over $5 million on their behalf, while directing their efforts toward problem areas and identifying procedural pain points.

Through those relationships, I’ve developed a deep knowledge of how an efficient Returned Goods Process should flow, from start to finish, and between departments, to ensure hospitals recoup the cost of products leaving their operating rooms and inventory storage facilities.

Andrew Adams is a Partner in the Advisory practice of EY, where he organizes and leads large transformation programs. He has over 15 years of experience supporting performance improvements that positively impact healthcare provider financial performance. Andy advises hospitals, health systems and physician practices and other healthcare providers across all aspects of the healthcare revenue cycle, including patient access, charge capture, coding operations and patient financial services. He also serves as a leader in the area of ICD-10 readiness. Andy’s experience includes technology optimization in the healthcare space, including vendor selection, requirements definition, independent program review, and program management.

Dave Dreher is a Partner in our Risk Advisory Services practice with more than 20 years of experience with internal audit, internal controls, enterprise risk assessment and risk management. Dave is the coordinating partner on several large risk advisory engagements overseeing the delivery of internal audit and risk management services for our clients. Dave also works with other companies across the Northeast Region providing risk, information technology and performance improvement services.

Dave also serves as the Northeast Region Health Risk Industry Leader responsible for developing area training events and content for thought leadership and for facilitating the development and exchange of industry-leading businesses to clients and EY professionals.

Joel Dziengielewski is a Director with Navigant’s Healthcare and Life Sciences Disputes, Compliance and Investigation (HLS-DCI) practice. Joel advises clients on the design, evaluation and implementation of ethics and compliance programs as outlined by various governance frameworks including the United States Federal Sentencing Guidelines, US Health and Human Services Office of the Inspector General Compliance Program Guidance, New York State OMIG Compliance Program Guidance, and SAS 99. Joel has advised clients in healthcare including providers and payors, pharmaceuticals, orthopedics, medical devices and select other industries.

Prior to joining Navigant, Joel was a Director at KMPG Forensic in New York City. Earlier, he served as Vice President & Chief Compliance Officer for Kaiser Permanente, one of the largest not-for-profit healthcare organizations in the country.

Molly Hinchey manages the corporate compliance and business integrity program at North Shore Medical Center. In the last year, she conducted an extensive audit of provider credentialing files which eventually lead to a reexamination of the credentialing process for physicians and allied health members at North Shore Medical Center. Molly received her undergraduate degree from Trinity College in Hartford, Connecticut and her JD from Boston College Law School in Newton, Massachusetts. Prior to settling at North Shore Medical Center, Molly worked in compliance at a large academic medical center in downtown Boston. She also spent time working in Medicare and privacy operations at a regional health insurance company outside Boston. In her free time she enjoys running and playing golf.

Speaker Biographies

June is certified in Healthcare Compliance, Healthcare Privacy Compliance, and MDS/RAC and has extensive experience in organizational management including regulatory and corporate compliance, administrative investigations, quality improvement, HIPAA implementation, and policy development. Her expertise in the health and human service sectors has provided her with the ability to transfer that knowledge and experience to assist a broad array of provider types including hospitals, nursing homes, human service agencies, physician practices, clinics, hospice, and home health care

Christine Savage is chair of the Healthcare Group at Choate and is recognized by Chambers USA, Best Lawyers in America and Massachusetts Super Lawyers. She was selected by Massachusetts Lawyers Weekly as a 2010 “Top Woman of Law” for outstanding leadership, vision, passion and advocacy in the healthcare industry. She represents hospitals, life sciences companies, research universities and funds who invest in a wide range of healthcare businesses in managing regulatory compliance issues and False Claims/Anti-Kickback/Stark Law allegations and self-disclosures.

Rebecca Matthews is a partner Wiggin and Dana’s Corporate and Health Care Departments, serving as the Co-chair of its Academic Medical Centers, Hospitals, and Health Systems Practice Group. Rebecca routinely counsels and represents academic medical centers, community hospitals and other provider on transactional and regulatory matters. The matters include affiliations, acquisitions and joint ventures. Rebecca also works with other health care providers, including nursing homes, ambulatory surgery centers, imaging centers, home health and visiting nurse agencies. Her work involves negotiation of complex transactional matters, construction of transactions consistent with fraud and abuse rules, and representation of providers before regulatory agencies on certificates of need and licensure matters. Having served as in-house counsel at a large academic medical center, Rebecca works collaboratively with clients and understands their complex operational and regulatory needs.

David Yarin is a principal with Deloitte & Touche LLP and brings more than 20 years of healthcare industry, consulting and project management experience. He has significant experience in leading and managing regulatory compliance, due diligence, litigation support, independent review organization (IRO), board advisory, special investigations (e.g. drug diversion), operational and financial consulting projects for healthcare provider, payer and life sciences organizations. Dave has served as an independent advisor to the board of directors of a for-profit national hospital system, international pharmaceutical manufacturer and medical device company pursuant to corporate integrity/deferred prosecution agreements. In addition, Dave has served several organizations as an interim chief compliance officer, assisted with both negotiation and implementation of corporate integrity agreements, and helped develop and review compliance programs for healthcare provider, payor, life science and non-healthcare organizations. In addition, Dave has served as an expert witness in multiple litigation matters. Prior to his consulting career, Dave worked as a physician group practice administrator for multi-specialty groups based in academic medical centers, including Brigham and Women’s Hospital in Boston, Massachusetts.

Heather Hagan is a Senior Manager in Deloitte’s Advisory practice and provides enterprise risk, regulatory compliance and internal audit services to health care organizations. Heather helps clients with the planning, preparation and implementation of changes as a result of regulatory disruptors, including MACRA. Additionally, Heather has extensive experience with the design and development of enterprise risk management programs, enterprise and enterprise-wide compliance risk assessments, compliance program development, effectiveness and optimization, internal and compliance auditing and monitoring, risk remediation assessments covering a variety of issues to impact including 340B drug pricing, physician contracting/arrangements and coding practices.

Adam Bruhnke is a Manager in PwC’s Risk Assurance Internal Audit Services practice with 9 years of experience providing advisory services related to

Speaker Biographies

internal audit, risk management and compliance. His experiences come from a mixture of “big four” and industry environments. Adam has participated in risk assessments, execution and management of numerous internal audit reviews, and participated in various consulting engagements. In addition, he has overseen operational, financial and compliance based reviews, which majority have been global in nature. Adam has also partnered with clients in developing enterprise risk management programs. During his career he has provided services across numerous industries: including healthcare, manufacturing, electronics, pharmaceuticals, government and entertainment and media.

Adam received his B.S. in Finance from Pennsylvania State University, his M.B.A from Empire State College and is a member of the Institute of Internal Auditors (“IIA”).

Vince Manuele is a member of the PwC Capital Projects & Infrastructure practice, where he advises corporate boards / executives and public entities on the planning and execution of capital projects, and on the resolution of disputes. A licensed attorney and a civil engineer, he has over 33 years of professional experience as a practicing construction attorney, a construction industry senior executive, and a global business consultant. Vince works with clients at all stages of the capital development lifecycle, providing advice on strategic planning, executive oversight, lifecycle governance, project delivery and contracting strategy, competitive sourcing and procurement, contract drafting and negotiation, risk management, contract administration and compliance, regulatory compliance, internal audit strategy / planning and review execution, forensic analysis of performance, negotiation of contract changes and claims, troubled project turnaround, and informal dispute resolution. He works across multiple industries, and has served as an arbitrator of capital project disputes.

Steve Gillis is the Director of Compliance Coding, Billing and Audit for Partners HealthCare System, which is the corporate organization founded by Massachusetts General Hospital and Brigham and Women’s Hospital here in Boston. Steve’s team is responsible for evaluating potential documentation, coding and billing risks across all of the PHS entities through data mining, medical record review and other ongoing risk assessment activities.

Prior to joining the Partners Corporate Compliance Office, Steve spent 5 years as Director of Billing Compliance for Massachusetts General Hospital and the Mass General Physicians Organization where he and his team audited practitioner documentation and billing activities, provided ongoing documentation coding and billing education and guidance, and responded to external audits and investigations. Before that, Steve spent 10 years as a compliance and regulatory consultant at PwC.

MaseQua Pina is a healthcare professional with exceptional experience in the full revenue cycle from registration to reimbursement. She has extensive knowledge in charge capture, coding, billing, compliance, and revenue enhancement. MaseQua is an Associate Compliance Officer at Yale-New Haven Health System. Her current responsibilities consist of oversight of the system revenue compliance audit program involving both professional and technical audits including but not limited to development, implementation and improvement of the system audit and education plans. MaseQua began her career at Yale-New Haven Health System twenty years ago and has held several positions in billing, contracting, revenue management, and compliance.

Documents

2016 AHIA REGIONAL · This presentation will provide an overview of the audit process, a look back at the Phase II audit period, and provide practical solutions and best practices