October 12- 13, 2022
Nashville, Tennessee

Elizabeth Lippincott will co-chair and speak at ACI’s Legal, Regulatory and Compliance Summit on Medicare Advantage from October 12-13, 2022, in Nashville, Tennessee.  Elizabeth’s co-chair is Karen Lam of Kaiser Permanente.  Elizabeth will be presenting alongside Teresa A. Mason of Epstein Becker Green and Julie Nielsen of Berkeley Research Group discussing Risk Adjustment: Forecasting the Future of Enforcement and the Implications for the Compliance and Legal Landscape.

The presentation will cover:

• Why CMS is not a plan’s biggest worry
• Analysis of oversight channels
  • CMS RADV audits
  • OIG Targeted and RADV-like audits
  • Whistleblower FCA litigation
  • DOJ perspective on risk adjustment as revealed in FCA litigation
• Insights on the relevance of actuarial equivalence and current applications in law
  • Overpayment rule
• Examining how plans calculate bid rates and risk score projections
• Forecasting potential outcomes for the CMS’ proposed rule and the implications for MAOs
  • Identifying calculation modifications and how to align internal processes to ensure compliance
  • how does it ultimately impact plans who are selected for RADV audit
• Developing compliance oversight of risk adjustment in the absence of cohesive guidance
• Determining what immediate corrective actions can be taken when FWA is detected

To learn more about Elizabeth Lippincott, please view her bio.