CompliancePalooza virtually unites compliance professionals from Medicare Advantage health plans to tackle the industry’s most pressing challenges from the CMS Final Rule and RADV updates to utilization management.
Wednesday - December 10, 2025
10:00 AM
10:00 AM – 10:05 AM
Welcome and Chairperson’s Opening Remarks
10:05 AM
10:05 AM – 10:50 AM
Keynote Address
Keynote Address: The New Rulebook for Compliance in Medicare Advantage: What CMS and OIG Expect in 2026
Overview of Final Rulings for 2025 and 2026 and what’s to come
10:50 AM
10:50 AM – 11:00 AM
Break
11:00 AM
11:00 AM – 11:50 AM
When Risk Adjustment Meets Reality: Improving Documentation Accuracy
- How can you connect the dots payers and providers to build sustainable and defensible programs
- Standardizing provider templates
- Ensuring continuity across care teams
- Refreshing education and communication regularly
- Foster a culture of documentation accountability
11:50 AM
11:50 AM – 12:00 PM
Break
12:00 PM
12:00 PM – 12:50 PM
Vetting Your Vendors
- How can you create a living compliance cycle to continuously vet your vendors
- Ensuring contracts are updated on an annual basis
- Who owns what–data sharing and clear ownership of what
- Embedding technology in new relationships for more oversight
12:50 PM
12:50 PM – 1:30 PM
Lunch Break
1:30 PM
1:30 PM – 2:15 PM
Closing the Compliance Gap: Building Accountability With Your Partners
- Make your partners part of the compliance structure
- Have shared data and dashboard visibility
- Creating a culture of co-ownership
- Constant and continuous oversight
2:15 PM
2:15 PM – 2:25 PM
Break
2:25 PM
2:25 PM – 3:10 PM
The Evolving Role of the CCO
- How to communicate compliance risk to executive and boards
- Ensuring transparency and informed decision making
- Demonstrating value of the compliance function and its critical role in risk management
3:10 PM
3:10 PM – 3:20 PM
Break
3:20 PM
3:20 PM – 4:05 PM
RADV Reimagined: Surviving the New Audit Landscape
- How to protect yourself with the inevitable comes
- Identifying documentation voids
- Being proactive on audit concerns
- How create an internal task force
4:05 PM
4:05 PM – 4:10 PM
Closing Remarks
Thursday - December 11, 2025
10:00 AM
10:00 AM – 10:10 AM
Chairperson’s Opening Remarks and Day One Takeaways
10:10 AM
10:10 AM – 11:00 AM
AI’s Promise and Peril
- Where is AI already embedded into workflows
- Where can AI be embedded into workflows
- What should you consider using an AI product or vendor
- How can AI proactively support teams
- What are the legal and ethical implications of utilizing AI
- How do you ensure there’s still human oversight
11:00 AM
11:00 AM – 11:10 AM
Break
11:10 AM
11:10 AM – 11:55 AM
Compliance and Long-Term, Post-Acute Care
- Building stronger oversight
- Improving clinical diagnosis and continuity
- Standardizing documentation
- Managing care intervention
11:55 AM
11:55 AM – 12:05 PM
Break
12:05 PM
12:05 PM – 12:50 PM
Data Governance: The Compliance Survival Strategy
- Data precision is the foundation of lawful payment
- Ensuring there’s processes to validate and reconcile data across all systems and parties
- You can outsource functions, but not the accountability
- Compliance is data and governance is what keeps it credible and ethical
- New 2026 transparency mandates
12:50 PM
12:50 PM – 1:30 PM
Lunch Break
1:30 PM
1:30 PM – 2:20 PM
Prior Authorizations: The Countdown to 2026
- Compliance strategies are under a new level of scrutiny
- How to ensure data accuracy and transparency
- Fixing the friction and inconsistencies
- Building and establishing provider trust
2:20 PM
2:20 PM – 2:30 PM
Closing Remarks
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