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Eastern Claims Conference PO Box 863902 Ridgewood, NY 11386 www.easternclaimsconference.com ECC Excellence Through Education February 22-24, 2015 Waldorf=Astoria New York City Dedicated to Life, Accident & Health and Disability Claims

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Page 1: ECC Eastern Claims Conference - it-mis.comit-mis.com/easternclaims/pdfs/ECC_2015_Invitation.pdfEastern Claims Conference PO Box 863902 Ridgewood, NY 11386 ECC Excellence Through Education!

 

EEaasstteerrnn CCllaaiimmss CCoonnffeerreennccee PPOO BBooxx 886633990022 RRiiddggeewwoooodd,, NNYY 1111338866

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ECC

Excellence Through Education

 

February 22-24, 2015

Waldorf=Astoria New York City

 

 

Dedicated to Life, Accident & Health and Disability Claims

 

 

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 Dear  Friends  and  Colleagues:  

Welcome   to   the   2015   Eastern   Claims   Conference   where   we   all   join   together   for   the   40th   Annual  conference.  We  are  so  glad  that  you  are  joining  us  in  New  York  City.    

As  the  Conference  Chairperson  and  on  the  behalf  of  the  entire  committee,   I  would   like  to  personally  thank   all   of   those   involved   in  working   so   hard   over   the   past   year   to  make   this   year’s   conference   a  success.  

Our   goal   is   to   provide   you   with   a   positive   and   fulfilling   learning   experience.   The   2015   agenda   is  designed  to  provide  attendees  with  the  tools,  strategies,  best  practices  and  motivation  to  contribute  to  and  lead  positive  change  within  their  organizations.    

This   is  your  opportunity  to   learn  from  the   leading   insurance   industry  professionals  and   legal  experts.  Our  speakers,  representing  the  insurance  industry,  will  present  and  discuss  the  latest  topics  from  their  area  of  expertise  including:  accidental  death  and  dismemberment,  life,  medical,  legal  and  fraud  issues.  They  will  share  with  you  their  strategies,  experiences  and  research  techniques.    

These  courses  were  designed  to  assist  you  in  your  personal  growth  as  an  insurance  professional.    This  is   an  excellent  opportunity   for   you   to  meet  with  other   insurance  professionals,   increase  your   claims  knowledge   and   sharpen   your   investigation   skills.   Most   importantly,   it   is   an   opportunity   to   come  together  to  reflect  and  share.    

We  are  also  pleased  with  our  success  in  obtaining  continuing  education  credits,  as  we  have  done  in  the  past,  with  various  associations  and  organizations.      

The   ECC   would   not   be   possible   without   our   valued   hospitality   sponsors,   exhibitors   and   Ad   Journal  sponsors.   I   would   also   like   to   express   my   gratitude   to   the   ECC   Board   of   Directors,   Committee  Chairpersons,  and  Committee  Members  and  extend  a  special  thank  you  to  our  speakers  who  volunteer  their  time  and  resources  to  share  their  knowledge,  expertise  and  experience  with  us.  

Lastly,  and  above  all,  we  would  like  to  thank  you  all  for  attending  and  for  your  loyalty.  We  look  forward  to  your  participation  in  this  premier  industry  event  and  to  welcoming  you  again  in  2016!    

Sincerely,  

Jennifer  Cobb,  CFE,  FCLS,  ALHC,  MBA  Conference  Chairperson,  Eastern  Claims  Conference  

         

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2015  Eastern  Claims  Conference  The  Waldorf=Astoria  Hotel  

New  York,  New  York  ECC  –  2015  

 SUNDAY,  FEBRUARY  22,  2015  

 REGISTRATION   1:30  p.m.  –  6:30  p.m.  (North  Foyer-­‐18th  Floor)    HOSPITALITY  RECEPTION   5:00  p.m.  –  6:30  p.m.  (Starlight  Roof)    MEET  AND  GREET  (First  time  attendees)   4:00  p.m.  –  5:00  p.m.  (18th  Floor)      

Only  Registered  Attendees  and  Pre-­‐registered  Guests  will  be  admitted  to  the  Hospitality  Receptions    

MONDAY,  FEBRUARY  23,  2015    REGISTRATION   7:30  a.m.  –  3:30  p.m.      EXHIBITORS’  RECEPTION   8:00  a.m.  –  9:00  a.m.  Palm  Room   A  light  breakfast  buffet  will  be  available  Starlight  Roof   Pastries  and  coffee  will  be  available.      WELCOME  ADDRESS   9:00  a.m.  –  9:15  a.m.  Starlight  Roof   Donna  A.  Conticchio,  ALHC,  HIA,  ACS     AIG  Benefit  Solutions,  Neptune,  NJ     President,  Eastern  Claims  Conference  Board      INTRODUCTION   Christine  Prutting     AXIS  Accident  &  Health,  Princeton,  NJ     Chair,  Program  Committee    KEYNOTE  ADDRESS   9:15  a.m.  –  9:45  a.m.     Byron  Darden,  MovesMaster    

Engage,  Motivate  And  Inspire    Engage,  Motivate  and  Inspire…The  3  P’s  of  the  Motivated  Soul  Kicking  off  the  Eastern  Claims  Conference  in  2015  will  be  an  address  by  Byron  Darden  of  MovesMaster.  Byron   is   a   trainer,   facilitator   and   change   agent   for   both   front   line   employees   as   well   as   executive  leaders  leveraging  his  change  management  and  organizational  effectiveness  skill  sets.        Be   prepared   to   be   “Engaged,  Motivated   and   Inspired”   as   Byron   raises   the   questions:    How   do   you  engage  others  to  gain  their  interest?  What  motivates  us  to  take  action  in  our  day-­‐to-­‐day  lives?  Where  do   I   look   for   inspiration   to   stay   the   course?   Our   best   intentions   may   set   us   in   motion   toward   a  particular   outcome   and   yet,   life   happens   when   we   are  making   plans.   Therefore,   planning   with   the  understanding  that  change  happens  allows  us  to  practice  our  flexibility  and  stay  focused  on  the  prize.  

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Come  join  us  and  learn  how  to:  Gain  the  top  tips  to  engage  others,    Discover  the  3  Ps  that  are  the  paths  to  motivation  and  Explore  tools  that  motivate  and  inspire  others  to  act!    

MONDAY,  FEBRUARY  23,  2015    CONCURRENT  SESSIONS   10:00  a.m.  –  11:15  a.m.    Panel  1.    Manner  of  Death:  How  Experts  Decide  Joye  M.    Carter,  MD,  J  and  M  Forensic  Consultants,  Indianapolis,  IN      Mark  C.    Stephenson,  Esq.,  Blue  Bell,  PA    Have  you  ever  wondered  how  medical  and  legal  experts  make  the  determination  of  whether  death  was  by   suicide,   homicide   or   accident?     Dr.   Carter   will   discuss   actual   case   scenarios   where   the   medical  opinion   was   not   easy   to   reach.   She   will   discuss   cases   where   evidence   was   compromised   by   the  investigation,  the  body  was  in  poor  condition  and  when  social  and  media  pressure  was  heaped  upon  the   hapless   coroner   trying   to   make   a   best   judgment   decision.   Dr.   Carter   will   also   discuss   how   the  examination,   both   physical   and   clinical   is   conducted   when   the   question   of   suicide   arises.   Mr.  Stephenson  will  discuss  how  the   law  determines  when  death   is  by  suicide,  homicide  or  accident,  the  role  of  foreseeability  and  intent,  and  the  legal  analysis  that  informs  specific  cases.    Panel  2.    The  Future  of  Disability  –  Point  &  Counter-­‐Point    Robert  Hess,  Esq.,  Barger  &  Wolen,  LPP,  Los  Angeles,  CA  Steve  Allen,  FLHC,  FLMI,  ACS,  Trustmark  Insurance  Company,  Worcester,  MA  Brian  Landry,  Claims  Bureau  USA,  Burlington,  MA    Experienced  counsel  and  claims  personnel  will  explore  and  debate  the  pros  and  cons  of  various  claim  handling   and   investigation   techniques,   including   challenges   presented   by   evolving   technology.     The  issues  will  be  discussed  in  a  Point/Counter-­‐Point  style,  with  audience  participation  encouraged.            Panel  3.    Peak  Performance  -­‐  The  Four  Attributes  of  a  Peak  Performer  Byron  Darden,  MovesMaster,  New  York,  NY    In    this    interactive    session,    the    audience    will    participate    in    identifying    the    attributes    of    a    peak  performer.  We  will  look    at  a  conceptual  model    that  will    serve    as    a    roadmap    anyone    can    use    to  strengthen  their  performance  at  work  with  teams,  at  home  with  family  as  well  as  friends  and  provide  insights  on  taking  your  performance  to  an  exemplary  level.  

• Identify  the  skills  and  behavior  associated  with  the  highest  level  of  professional  performance  • Learn  about  a  conceptual  model  designed  to  develop  and  track  high  performing  individuals  • Distinguish  the  difference  between  power  and  force;  how  one  influences  and  one  undermines  

performance        Panel  4.    Taming  the  New  Frontier  –  New  Compliance  Obligations,  Enforcement  and  Litigation  Under  The  Affordable  Care  Act  John  T.  Seybert,  Esq.,  Sedgwick  LLP,  New  York,  NY  Ernest  N.  Dixon,  CPA/CFF  Berkeley  Research  Group,  Tampa,  FL    Christine  A.  Prutting,  AXIS  Accident  &  Health,  Princeton,  NJ  

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 In  the  past  two  years,   issues  regarding  the  Affordable  Care  Act  have  been  presented  and  decided  by  the  U.S.  Supreme  Court.    At  least  one  more  issue  is  on  the  horizon.  The  panel  of  speakers  will  provide  you   with   the   tools   needed   to   survive   in   this   new   frontier   of   this   controversial   legislation   and   ever  changing   regulation.     The   panel   will   also   help   you   spot   the   pitfalls   and   dangers   of   compliance  obligations,  potential  litigation  and  enforcement  risks.      Panel  5.    The  Global  Economy  of  Healthcare  Fraud  Rebecca  S.  Busch,  RN,  MBA,  CCM,  CBM,  CPC,  CHS-­‐III,  CFE,  FIALCP,  FHFMA,  Medical  Business  Associates,  Westmont,  IL    Samantha  Busch,  CFE,  Medical  Business  Associates,  Westmont,  IL    

Healthcare  fraud  is  the  biggest  target  of   identity  theft  at  both  a  national  and  international   level.  This  session  will  present  an  international  perspective  on  healthcare  fraud,  such  as  the  improper  use  of  ICD  codes,  deceptive  practices,  and  how  to  prevent  existing  and  evolving  schemes.  We  will  look  at  the  new  objectives  and  unique  behaviors  of  the  ethically  challenged.  Presentation  Points:  

1.   ICD  codes  2.   What  Drives  Fraud  3.   Types  of  Fraud  at  an  International  Level  4.   Case  Studies  

 MONDAY,  FEBRUARY  23,  2015  

 EXHIBITORS’  RECEPTION   11:15  a.m.  –  12:00  p.m.  Starlight  Roof  &  Palm  Room    LUNCH   12:00  p.m.  –  1:00  p.m.  Starlight  Roof  

MONDAY,  FEBRUARY  23,  2015    CONCURRENT  SESSIONS   1:15  p.m.  –  2:30  p.m.    Panel  6.    Compelling  Life  Insurance  Beneficiary  Issues  William  Hittler,  Esq.,  Nilan  Johnson  Lewis  PA,  Minneapolis,  MN  Peter  Sailor,  Esq.,  Reliance  Standard  Life,  Philadelphia,  PA  Les  Kertay,  Ph.D.,  ABPP,  Behavioral  Medical  Interventions,  Edina,  MN  Brandie  Morgenroth,  Esq.,  Nilan  Johnson  Lewis  PA,  Minneapolis,  MN    Address  the  challenges  facing  life  insurance  administrators  under  ERISA  and  state  law  when  confronted  with  competing  claims  by  beneficiaries,  including  the  existence  of  a  valid  waiver  of  the  right  to  receive  benefits,  the  "substantial  compliance"  rule,  and  the  "Plan  Document".    In  addition,  the  panel  will  discuss  situations  involving  the  validity  and  priority  of  beneficiary  designations,  disputes  between  competing  beneficiaries,  powers  of  attorney,  changes  in  designation  in  divorce  proceedings  and  designations  procured  by  fraudulent  means.  Finally,  the  panel  will  explore  the  underlying  dynamics  of  a  beneficiary's  perspective  and  the  inherent  conflict  between  psychological  behaviors  and  the  insurer's  obligation  to  make  the  correct  claim  decision  based  on  the  policy's  contract  language.    

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         Panel  7.    What’s  My  Line?  –  RVU  Analysis  is  Not  a  Guessing  Game  Ernest  Patrick  Smith,  CPA,  CVA,  CFE,  Nawrocki  Smith  LLP,  Melville,  NY    John  M.  Spatola,  CPA,  ABV,  CFF,  CVA,  CFE  Nawrocki  Smith,  LLP,  Melville,  NY  David  Jackson,  MA,  CRC,  Mass  Mutual,  Springfield,  MA    This  session  will  take  the  mystery  out  of  what  an  RVU  is  and  why  they  are  helpful  in  analyzing  a  physician's  occupational  duties.    With  real  case  examples  we  will  show  how  to  analyze  and  interpret  the  RVU  data.    We  will  explain  how  it  provides  crucial  information  needed  to  understand  the  physician's  occupation  as  it  relates  to  their  policy.        Panel  8.    Building  Effective  Relationships  –  How  We  Benefit  from  Knowing  About  Others  and  Ourselves  Byron  Darden,  MovesMaster,  New  York,  NY    Explore  the  key  details  about  people  with  whom  we  communicate  and  engage  with.  This  knowledge  can  make  the  difference  between  getting  things  done  or  left  undone  due  to  our  unawareness.  The  art  of  building  a  relationship  starts  with  how  we  listen,  what  we  listen  to  and  how  we  respond  to  what  we  hear.  We  will  also  engage  in  an  activity  designed  to  practice  this  invaluable  art  form.        Panel  9.    Life  Case  Law  Update:    The  Next  Dimension  Adrienne  C.  Publicover,  Esq.,  Wilson,  Elser,  Moskowitz,  Edelman  &  Dicker  LLP,  San  Francisco,  CA  Eric  Myers,  Esq.,  AIG  American  General,  Houston,  TX      Learn  about  the  most  current  cases  and  developments  impacting  life  insurance  claim  administration  in  both  the  United  States  and  Canada.    Listen  to  experienced   inside  and  outside  counsel  explain  recent  cases  and  trends  in  life  insurance  case  law  and  litigation  developments.    Panel  10.    Boosting  Chiropractic  Revenue  Under  the  Guise  of  Medicine  Dr.  Tom  Jones,  D.C.,  C.E.S.,  CCRD,  CSCS  Independent  Consultant,  Toms  River,  NJ    The   ever-­‐fascinating  Dr.   Jones  will   bring   you   up   to   date   on   questionable   issues   involved   in  multiple  disciplinary  clinics.    We  will  also  cover:  

• Multiple  billing  codes  for  soft  tissue  injuries,  when  is  it  appropriate?  • Interpreting  medical-­‐legal  reports  to  support  treatment  and  overall  cost  • Identifying  excessive  care  and  billing  procedures  compared  to  proper  care  

           

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MONDAY,  FEBRUARY  23,  2015    CONCURRENT  SESSIONS   2:45  p.m.  –  4:00  p.m.    Panel  11.    Investigating  the  Contestable  Claim  Valerie  Loftin,  JD,  Munich  Re,  Atlanta,  GA  Iraida  Labra,  FLMI,  ALHC,  ARA,  Munich  Re,  Atlanta,  GA  Amy  Atkinson,  Esq.,  Munich  Re,  Atlanta,  GA    An  interactive  and  informative  session  on  industry  best  practices  in  the  investigation  and  resolution  of  contestable  life  insurance  claims.      Panel  12.    What’s  the  Future  for  Social  Security  Disability  Insurance?  Steve  Clayburn,  FSA,  MAAA,    American  Council  of  Life  Insurers,  Washington,  DC    Stan  Kulesa,  HIA,  ALHC,  ACS,  CPDM,  The  Standard,  White  Plains,  NY      The  media  has  provided  a  great  amount  of  coverage  concerning  the  solvency  of  the  SSDI  trust  fund.    They   have   also   provided   insight   into   a   number   of   instances   during   which   the   SSDI   program   was  defrauded.    One  example  of   this  was   the  Wall   Street   Journal   article,   “Grand   Theft  Disability”,  which  spoke   to   the   “rampant   abuse”.     Over   the   recent   past,   there   have   been   many   proposals   and   ideas  circulated  by  special  interest  groups,  politicians,  bureaucrats  and  others,  suggesting  assorted  changes  to   the  SSDI  program  with   the  noble  goal  of  ensuring   its   future.    Our   speakers  will   share   information  about   some   of   the   more   prominent   potential   solutions   being   considered   and   their   impact   on   our  industry.        Panel  13.    Building  Brand  ME:  Essential  for  2015  and  Beyond  Mark  Flamendorf,  Crum  &  Forster,  Morristown,  NJ  Kim  McConnell,  McConnell  Leadership  Group,  Summit,  NJ    Your  Brand  ME  says  a  lot  about  you  –  it’s  how  you  show  up  in  the  world.    Your  Brand  ME  is  what  the  world  sees  –  it’s  your  personality,  how  you  look,  how  you  talk,  your  promises,  your  personal  ambiance,  your  gifts.    Your  Brand  ME  needs  to  be  authentic,  valuable  and  memorable…  after  all,  it’s  your  special  mark.    This  interactive,  engaging  and  fun  session  will  help  you  magnify  your  Brand  ME  –  a  brand  that  is  more   important  today  than  ever  before.     In  our  world  of  brand  differentiation,  what  sets  you  apart?    Who  do  you  want  to  buy  your  Brand  ME  –  is  your  current  Brand  ME  a  match?    Brands  build  legacies  –  what  is  your  brand  legacy?    Panel  14.    A  Chicken  and  Egg  Problem  with  AD&D  Claims?    E.  Ford  Stephens,  Esq.,  Christian  &  Barton  LLP,  Richmond,  VA  Gary  Schuman,  Esq.,  Combined  Insurance  Company  of  America,  Glenview,  IL    Over   the   last   few   years,   ECC   presentations   on   accidental   death   and   dismemberment   have   covered  various  scenarios  and  concepts.    This  year,  our  presenters  –  experienced  in-­‐house  and  outside  lawyers  –  will  focus  on  what  can  be  a  vexing  interplay  between  preexisting  conditions  and  accidents.    When  an  insured   has   a   preexisting   condition   at   the   time   of   an   accident,   what   factors   do   courts   consider   in  

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determining   whether   the   loss   is   compensable   under   AD&D   coverage?     What   do   exclusions   for  preexisting   conditions   add   to   the   analysis?     And   how   are   medical   treatment   and   prescription   drug  exclusions   applied   in   such   situations?     Come   ready   to   share   your   own   claim  experiences   and   join   in  what  promises  to  be  an  interesting  discussion.        Panel  15.  Auditing/Interpretation  of  Electronic  Health  Records  (EHR)  Rebecca  S.  Busch,  RN,  MBA,  CCM,  CBM,  CPC,  CHS-­‐III,  CFE,  FIALCP,  FHFMA,  Medical  Business  Associates,  Westmont,  IL    Samantha  Busch,  CFE,  Medical  Business  Associates,  Westmont,  IL    As   the   integration   of   EHR   systems   continues   to   evolve,   so   do   the   methods   by   which   the   ethically  challenged  continue  to  avoid  detection.  With  every  EHR  system  comes  new  and  unique  opportunities  for   fraud,  waste,   and   abuse   that  must   be   properly  managed   by   examiners.   From   identifying   all   the  players,  to  cross  referencing  databases  and  developing  crucial  benchmarks,  this  session  will  cover  the  ins  and  outs  of  combating  fraud  in  the  newly  digitized  world  of  healthcare  delivery.  Presentation  points:  

1.  The  Basic  Building  Blocks  of  Deception  2.  The  Nuances  of  Auditing  EHR  3.  The  Importance  of  “Real-­‐Time”  Data  Capture  4.  The  Methodology  for  Detection  

 HOSPITALITY  RECEPTION   5:00  p.m.  –  6:30  p.m.  Starlight  Roof  

 Only  Registered  Attendees  and  Pre-­‐registered  Guests  will  be  admitted  to  the  Hospitality  Receptions  

   

TUESDAY,  FEBRUARY  24,  2015    REGISTRATION   8:00  a.m.  –  1:55  p.m.  North  Foyer  –  18th  Floor    EXHIBITORS’  RECEPTION   8:00  a.m.  –  9:00  a.m.  Starlight  Roof  &  Palm  Room   Pastries  and  coffee  will  be  available  

   

TUESDAY,  FEBRUARY  24,  2015    CONCURRENT  SESSIONS   9:00  a.m.  –  10:15  a.m.    Panel  16.  Marijuana  -­‐  What  is  Impairment?      Lynette  Crow-­‐Iverson,  Conspire!,  Colorado  Springs,  CO  William  D.  Nelson,  Esq.,  Lewis,  Roca,  Rothgerber,  LLP,  Colorado  Springs,  CO    Marijuana   use   and   Claims—the   myriad   of   issues   facing   today’s   employers   including   medical   and  recreational  use  of  marijuana  on-­‐site  and  off-­‐site,  accommodation,  zero-­‐tolerance  policies,  the  impact  

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on   government   contractors   and   grantees,   the   role   and   scope   of   testing   and   what   constitutes  impairment.    Panel  17.  Fast  Lane  Financials      John  Hoffman,  CPA,  CFF,  CITF,  Nawrocki  Smith,  LLP,  Melville,  NY  John  Spatola,  CPA,  ABV,  CFF,  CVA,  CFE,  Nawrocki  Smith,  LLP,  Melville,  NY    Ernest  Smith,  CPA,  CVA,  CFE,CFF,  ABV,  Nawrocki  Smith,  LLP,  Melville,  NY  Dimitris  Bantileskas,  CPA,  Nawrocki  Smith,  LLP,  Melville,  NY  John  Castles,  CPA,  CFE,  Nawrocki  Smith,  LLP,  Melville,  NY      Earned   Income   is   not   always   straightforward.     Passive/Non-­‐Passive   Entities,   Unusual   Compensation  Arrangements,  Complex  Business  Structures,  Activity  Based  Expense  Analysis,  CPT/RVU  Analysis,  Soft  Expenses,  Management  Companies,  Trends  with  Physicians.  If  any  of  these  topics  interest  you,  this  is  a  must  attend.    A  fast  paced,  succinct  discussion  by  a  panel  of  experts  on  topics  that  challenge  everyone  who  manages  disability  claims.    Panel  18.    Online  Investigations  and  Research  Techniques  and  Strategies  Karen  Weintraub,  MA,  AHFI,  CPC-­‐P,  CPMA,  Healthcare  Fraud  Shield,  Chesterfield,  MO    Demonstrated   through   real-­‐time   searches,   this   session  will   walk   participants   through   various   public  websites  and  others  providing  a  step-­‐by-­‐step  tutorial.    This  session  will  include  different  site  resources  for  different  types  of  investigations  and  the  best  methods  to  elicit  information  from  the  web.    Panel  19.  ERISA  Disability  -­‐  Hot  Button  Topic  Sherril  Colombo,  Esq.,  Littler,  Mendelson,  P.C.,  Miami,  FL  Richard  Lodi,  Life  Insurance  Company  of  North  America,    Dan  Srsic,  Esq.,  Littler,  Mendelson,  P.C.,  Columbus,  OH    This  panel  will  discuss  issues  on  the  minds  of  those  in  claims  as  well  as  legal  counsel,  such  as:  

• The  Treating  Physicians’  Opinions  versus  Peer  Reviews  • Subjective  Symptom  Claims  and  Pain  Medication  • Overpayments  and  Offsets  • SSDI  Award  Determinations  and  their  Impact  on  Disability  Benefits  • Cases  where  the  courts  are  remanding  the  claim  back  to  the  Administrator    

 Panel  20.  Pharmacy  Fraud  Update  –  From  Entry  to  Exit    Matthew  H.  Berls,  MA,  UnitedHealthcare,  Iselin,  NJ  Alena  Dietz,  CPHT,  UnitedHealthcare,  Frederick,  MD    The  “Pharmacy  Fraud  Update  –  From  Entry  to  Exit”  will  analyze  various  fraud,  waste  and  abuse  components  impacting  pharmacy  investigation  and  a  health  plan  pharmacy  network.    Primary  areas  of  focus  will  include,  but  not  be  limited  to:    

• Evolution  of  Pharmacy  Fraud  Investigations  –  A  high-­‐level  overview  on  the  progression  of  pharmacy  fraud  investigation,  starting  with  overutilization  of  controlled  substances  to  identified  diversion  of  “high  cost  medication”  to  now  an  abuse  of  compounds.  

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• Prevention   of   Fraudulent,   Wasteful   and   Abuse   (FWA)   Activities;   PBM   v.   Health   Plan  Credentialing   of   Contracted   Pharmacies   Processes,   Enhanced   FWA)   Credentialing  Programs;  High  Risk  Pharmacies,   i.e.   independent-­‐retail  pharmacies  and  HEAT  Counties;  Pharmacy  Compliance  Inspections  &  Background  Searches.        

TUESDAY,  FEBRUARY  24,  2015    CONCURRENT  SESSIONS   10:30  a.m.  –  11:45  a.m.    Panel  21.    Group  Life  Claims  Challenges  William  Woods,  Esq.,  New  York    Robert  P.  Lesko,  Esq.,  Wilson,  Elser,  Moskowitz,  Edelman  &  Dicker  LLP,  Florham  Park,  NJ      Group  Life  claims  present  layers  of  challenges  to  the  claims  professional.  This  session  will  focus  on  the  plan  provisions  that  present  the  greatest  tests.  Expert  presenters  will  discuss  No  Loss/No  Gain  clauses,  Eligibility  issues,  such  as  when  a  plan  administrator  does  not  properly  manage  the  plan,  the  standard  of  proof  for  evidence  of  actively  at  work  and  adjudicating  claims  under  Taft  Hartley  plans.          Panel  22.    Mind  Over  Matter?  Lori  Cohen,  Ph.D.,  Independent  Claim  Consultants  Network,  LLP,  Haydenville,  MA  Ann  Marks,  MD,  New  England  Medical  Consultants,  Florence,  MA    Nearly   one   third   of   all   primary   health   care   visits   and   80%   of   all   health   care   dollars   are   devoted   to  "somatizing  syndromes".  Find  out  if  this  applies  to  your  claimant.  A  treating/peer  review  physician  and  a  consulting  forensic  psychologist  explore  signs,  diagnoses  and  treatment  options  for  these  prevalent  and  complicated  claims.  

 Panel  23.    How  Employee  Engagement  Impacts  Work  Productivity  Lisa  Stevens,  The  Guardian  Life  Insurance  Company,  Appleton,  WI    Jeff  Smith,  CDMS,  CCM,  The  Standard,  White  Plains,  NY        It  is  well  documented  that  employees  who  are  engaged  by  their  employer  produce  better  quantitative  and  quantitative  results.    It’s  not  just  classroom  learning,  it’s  a  shift  in  the  corporate  culture.    We  will  share   information   about   how   employee   engagement   initiatives   are   developed,   implemented,   and  monitored.     The   presentation   portion   of   this   session   will   lead   to   an   open   discussion   among   the  attendees  on  the  steps  that  they’ve  taken  or  are  considering  to  engage  their  employees.      

 Panel  24.    Life  Betting  –  A  STOLI  Update    Edith  Sanchez  Shea,  Esq.,  Burke,  Williams  &  Sorensen,  LLP,  Los  Angeles,  CA      This   session  will   provide   a   review  of   the   background  of   Stranger-­‐Originated   Life   Insurance   ("STOLI")  and  an  update  on  the  current  state  of  the  law.          

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Panel  25.    Effective  Data  Mining  Techniques  –  Can  You  Dig  It?  Karen  Weintraub,  MA,  AHFI,  CPC-­‐P,  CPMA,  Healthcare  Fraud  Shield,  Chesterfield,  MO    Attendees  will  learn  to  ‘dig’  into  and  ‘drill’  down  on  large  amounts  of  data  using  Excel  and  Access.    We  will   explore   a   variety   of   data   mining   techniques.   Attendees   will   leave   with   the   skills   needed   to  comprehensively  manage   large  data   sets   to  easily   identify   the  outliers.     In   addition,   this   session  will  cover  tips  and  tricks  to  increase  efficiency  while  utilizing  the  different  data  mining  tools.    We  will  apply  what   you   learn   and   ‘construct’   a   Case   from   start   to   finish   demonstrating   the   use   of   these   tools   in  action.    Hard  hats  are  optional.        

TUESDAY,  FEBRUARY  24,  2015    EXHIBITORS’  RECEPTION   11:45  a.m.  –  12:30  p.m.  Starlight  Roof  &  Palm  Room    LUNCH   12:30  p.m.  –  1:30  p.m.  Starlight  Roof    LUNCHEON  SPEAKER   David  W.  Grannan,  CFE     UnitedHealthcare     President,  International  Claim  Association          

TUESDAY,  FEBRUARY  24,  2015    CONCURRENT  SESSIONS   1:45  p.m.  –  3:00  p.m.    Panel  26.    Beneficiary  Location:  The  Hidden  Cost  of  Unclaimed  Property  Legislation  Paul  MacCready,  Keane,  Overland  Park,  KS  Johnny  O’Mahony,  John  Hancock  Life  Insurance,  Boston,  MA        Review  the  operational  impacts  of  beneficiary  search  requirements.    Learn  the  status  of  legislation  and  take  industry  best  practices  back  to  your  company.        Panel  27.    Make  My  Day:    Fighting  Fraud  in  Life  and  Disability  Insurance  Claims  Steven  P.  Del  Mauro,  Esq.,  McElroy,  Deutsch,  Mulvaney  &  Carpenter,  LLP,  Tinton  Falls,  NJ    This panel was developed to train associates as a guide and to assist in issue spotting. It will demonstrate how to provide a thorough, complete and fair review of each claim and show you the steps to eliminate or greatly reduce the company’s liability and exposure to extra contractual liability/bad-faith. “Tee-up” the case – achieve rescission while substantially reducing attorney fees and costs. NO SURPRISES!      

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Panel  28.    You  Just  Received  1000  Pages  of  Medical  Records  -­‐  What’s  Next?  -­‐  Medical  Records  Review  Cathy  Alberti,  ALHC,  FCLS  Disability  Management  Services,  Springfield,  MA  Jodi  Newton,  BS,  RN,  CCM,  Disability  Management  Services,  Springfield,  MA  Nick  DeFilippis,  Ph.D.,  Atlanta  Psychological  Associates,  Atlanta,  GA    Whether  you  are  new  to   the   industry  or  an  experienced  professional,   you  all  have   faced   the   task  of  scaling  a  mountain  of  medical  records.  Where  do  you  start?  What  is  important?  Do  you  have  to  read  every  page?  Our  panel  of  experts  will  guide  you,  helping  you  focus  on  the  fundamental  elements  of  a  file  review  and  mapping  out  strategies  for  both  routine  and  complex  claims.    Panel  29.    Case  Study  on  Disability  Fraud  David  Szuchman,  JD,  New  York  County  District  Attorney’s  Office,  New  York,  NY      Despite  the  steps  taken  by  the  disability  insurance  industry  to  mitigate  the  effects  of  fraud,  there  are  always   examples   where   more   could   have   been   done.     One   recent   newsworthy   example   of   fraud  affecting   our   industry   involved   a   group   of   employees   from   the   Long   Island   Railroad,   some   of   their  treating  providers,  and  a  range  of  other  factors  that  led  to  serious  problems.        Panel  30.    DME  –  The  Part  C/D  Diabetic  Testing  Supply  (DTS)  Tango  Matthew  H.  Berls,  MA,  UnitedHealthcare,  Iselin,  NJ  Benjamin  Wilbur,  CFE,  UnitedHealthcare,  New  York,  NY  Robert  Battista,  CFE,  CIFI,  FCLA,  UnitedHealthcare,  New  York,  NY    The  “DME  –  The  Part  C/D  Diabetic  Testing  Supply  (DTS)  Tango”  will  analyze  various  fraud,  waste  and  abuse   components   impacting   pharmacy   and   medical   investigations.     Primary   areas   of   focus   will  include,  but  not  be  limited  to:  

• Various   violations   as   it   relates   to   Diabetic   Testing   Supplies   and   other   Durable   Medical  Equipment,   i.e.  Cold  Calling  Schemes,  Aggressive  Telemarketing,  Duplication  of  DTS,  Billing  for  Deceased  Beneficiaries,  Drop  Shipping,   False  Claims,   Sleeper  Cells/Entities,  Waiver  of  Copays,  etc…  

• Cross-­‐over  billing  of  DTS  to  a  health  plan’s  pharmacy  benefits,  Establishment  of  Pharmacies  to  circumvent   competitive   bidding,   Review  of   Pharmacy  Network  Agreement(s),  Miles   to  Great,  Member  Interviews,  Falsification  of  Records,  etc.  

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                                                                         Notes  

• The  attendee  registration  fee  includes  admission  to  the  Hospitality  Receptions.    However,  if  you  bring  a  guest  (a  colleague  or  spouse),  a  $200  fee  is  payable  for  your  first  Pre-­‐registered  Guest  wishing  to  attend  the  receptions.    The  fee  covers  both  receptions.    A  $150  fee   is  payable   for  each  Additional  Guest,  per  event.  

 

• If  you  have  special  needs,  please  contact  Arlene  Walsh  at  718  497  7886  or  [email protected].    

• Business  dress  is  encouraged.    

• There  will  be  a  $50  late  fee  added  to  registrations  received  after  January  31,  2015.    

• There  will  be  no  refunds  for  cancellations  received  after  January  31,  2015.    

THE  FEDERAL  TAX  ID  NUMBER  FOR  THE  ECC  IS  20-­‐8483688  

Attendee  Registration  Fees  for  2015  

2  days  with  lunch   $625  2  days  without  lunch   $500  1  day  with  lunch   $425  1  day  without  lunch   $350  First  Pre-­‐registered  guest   $200  Each  additional  guest  (per  event)   $150  Late  fee  after  January  31,  2015   $    50      

Waldorf  =  Astoria  301  Park  Avenue  

New  York,  NY    10022-­‐6897  1  877  GROUP  WA  (1  877  476  8792)  

Hotel  Rates  for  2015  (Use  Hotel  Code  ECC)  

 Accommodations   Single/Double  Deluxe  Queen   $299  King  Bed  &  Double/Double  Superior  Room   $299  King  Bed  Luxury  Room   $359    

• All  Room  rates  are  subject  to  state  and  local  taxes,  currently  14.75%,  $2.00  Occupancy  tax,  and  $1.50  Jacob  Javits  Center  fee  per  room,  per  night.  

• A  credit  card  is  required  to  make  a  reservation.  • If  you  need  to  cancel  your  hotel  room,  please  do  so  one  day  prior  to  

arrival  to  avoid  cancellation  fee.  • Hotel  Check-­‐in  time  is  3  p.m.