Avoiding the Medical Necessity Hot Seat

Navigating Peer Review, Compliance, and the Law

How sure are you that the care provided by your physicians today is truly medically necessary? How do you know?

If you don’t have clear answers to these questions, you could end up in the medical necessity hot seat, and that can get very costly, very fast. Join The Greeley Company’s CMO, Rick Sheff, MD and attorney Chad Eckhardt of Frost Brown Todd to learn what you need to do to avoid being the next hospital facing a tough Office of Inspector General (OIG) investigation.

You’ll learn about recent CMS/OIG settlements in the tens of millions that have hospitals and systems thinking twice about trusting the medical staff’s regular peer review process to adequately evaluate medical necessity and take proactive steps if/when self-reporting is warranted. Participants will understand the difference between what the OIG is looking for verse what medical staffs look for, when and how to use external peer review as a check and balance for your medical staff’s peer review, and what steps your organization can take to be more compliant and proactive.

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Featured Speakers

Rick Sheff, MD
Chief Medical Officer, The Greeley Company
Dr. Rick Sheff is a chief medical officer of The Greeley Company, a nationally respected healthcare solutions firm. He brings over 30 years of healthcare management and leadership experience to his work with physicians, hospitals and healthcare systems and has co-authored 15 books on the subject. Prior to joining Greeley, Dr. Sheff served as a VPMA, president of an independent practice association, and held multiple medical director positions. He taught at Tufts University School of Medicine and served as chair of the Massachusetts Academy of Family Practice Research Committee.

Chad Eckhardt
Attorney, Frost Brown Todd
Chad Eckhardt is a partner in Frost Brown Todd’s regulated business group and vice chair of the healthcare industry group. Chad focuses on the healthcare industry, advising businesses and healthcare entities in corporate matters, formation and structuring, contract negotiation, and regulatory compliance. He has assisted hospitals, physician practices, ancillary service providers and related entities on mergers, acquisitions, and clinical integrations, as well as, issues pertaining to stark, anti-kickback, billing compliance, recovery auditor programs, HIPAA, licensing, healthcare reform and other regulatory and transactional aspects of the industry.

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