Let s Talk Tuomey: The Fourth Circuit s Recent Stark Analysis and Its Impact on Hospital Physician Arrangements
|
|
- Veronica Cain
- 5 years ago
- Views:
Transcription
1 Let s Talk Tuomey: The Fourth Circuit s Recent Stark Analysis and Its Impact on Hospital Physician Arrangements This roundtable discussion is brought to you by the Fraud and Abuse (Fraud) Practice Group, and is co-sponsored by the Business Law and Governance (BLG), Hospitals and Health Systems (HHS), and Physician Organizations (Physicians) Practice Group. April 16, :00-1:00 pm Eastern Moderator and Presenter Gary W. Herschman, Esquire, Sills Cummis & Gross PC, Newark, NJ, gherschman@sillscummis.com Presenters William W. Horton, Esquire, Johnston Barton Proctor & Rose LLP, Birmingham, AL, whorton@johnstonbarton.com Julie E. Kass, Esquire, Principal, Ober Kaler, Baltimore, MD, jekass@ober.com 1
2 THE FACTS
3 The Facts Tuomey offered physicians on its medical staff part-time employment agreements with a wholly-owned Tuomey subsidiary, only when they were performing outpatient surgeries at the hospital. Physicians agreed to perform outpatient procedures exclusively at Tuomey for 10 years. 2-year, 30-mile post-termination non-competition provision. 3
4 The Facts (cont d.) Physician compensation: tiered base salary tied to collections of personally performed services productivity bonus totaling 80% of collections up to an additional 7% of collections for meeting certain quality measures full-time benefits 4
5 The Facts (cont d.) Gov t alleged the total compensation to the physicians (salary and benefits), on average, was 19% higher than the PC collections. Tuomey received a FMV report stating that the physicians compensation was justifiable so long as it did not exceed 150% of the 90 th percentile a methodology which was rejected by both parties experts. 5
6 The Facts (cont d.) At trial, both parties agreed that if Stark applied, the arrangement should be analyzed as an indirect compensation arrangement. The gov t argued that the arrangements did not meet the ICA exception because the compensation took into account the volume or value of the physicians referrals. 6
7 PROCEDURAL HISTORY
8 Procedural History March 2010 Jury Verdict: Tuomey violated the Stark Law. Tuomey did not violate the federal False Claims Act ( FCA ). In July 2010 rulings on post-trial motions, the district court: Enters a $45 million judgment for payment by mistake of fact and unjust enrichment based on Stark violation. Set aside the verdict with respect to FCA Ordered a new trial 8
9 ARGUMENTS ON APPEAL
10 Tuomey s Position on Appeal to the 4 th Circuit Tuomey appeals arguing that the Stark Law does not apply in the first instance because there is no indirect compensation arrangement. Physicians only paid for personally performed services. 10
11 Tuomey s Position on Appeal (cont d.) Under Stark, an indirect compensation arrangement exists if the referring physician receive[s] aggregate compensation that varies with, or takes into account, the volume or value of referrals or other business generated by the referring physician. A referral excludes any DHS personally performed or provided by the referring physician. 11
12 The Government s Arguments on Appeal The gov t argued that the compensation: varied with the volume/value of referrals because the physicians only earned $ for work that simultaneously generated a TC; took into account the volume or value of referrals by including a portion of corresponding TC fee; was designed to exceed collections for the PC, by including an amount to compensate for TC referrals. 12
13 THE FOURTH CIRCUIT OPINION
14 The Fourth Circuit Opinion On March 30, 2012 the Fourth Circuit overturned the judgment. Found a violation of Tuomey s 7th Amendment right to a jury trial. District court set aside entire jury verdict Thus, no factual basis to sustain the equitable claims. 14
15 The Fourth Circuit Opinion (cont d.) However, the 4th Circuit also addressed two Stark issues which were raised on appeal and were likely to recur on remand: Does the facility component that results from a personally performed service constitute a referral? Do the contracts implicate the volume or value standards by taking into account anticipated referrals? 15
16 IS THE TC A REFERRAL?
17 Is the TC a Referral The court cited 66 Fed. Reg. 941: When a physician initiates a DHS and performs it him or herself, that action would not constitute a referral However, in the context of inpatient and outpatient hospital services, there would still be a referral of any hospital service, technical component, or facility fee billed by the hospital in connection with the personally performed services. 17
18 Is the TC a Referral? (cont d.) Based on preambles, the court concluded that the facility/technical component of the physician s personally performed services constitutes a referral. Thus, Tuomey s previous argument that the physicians were not making referrals fails. 18
19 THE VOLUME OR VALUE STANDARD
20 Do the Contracts Implicate the Volume or Value Standard? 4 th Circuit cites to Stark FMV Definition: compensation that has not been determined in any manner that takes into account the volume or value of anticipated or actual referrals. 42 FR
21 Volume or Value Standard (cont d.) 66 Fed. Reg. 877: We will not consider the volume or value standard implicated by otherwise acceptable compensation arrangements so long as the payment is fixed in advance is consistent with fair market value for the services performed (that is, the payment does not take into account the volume or value of the anticipated or required referrals). 21
22 Volume or Value Standard (cont d.) Court s Conclusion: physicians should be compensated for the services they actually perform and not for their ability to generate referrals. Thus: The jury must consider whether: The contracts, on their face, took into account the volume or value of referrals; and Whether the compensation did not meet the FMV standard by taking in to account anticipated referrals in computing the physician s compensation. Intent alone does not create a violation. 22
23 Implications of the 4 th Circuit s Decision
24 What Do We Know for Certain? The fact that a physician is being paid for personally performed services does not automatically mean that Stark is a non-issue. In the case of inpatient/outpatient hospital services, a Stark analysis will always be necessary because there will always be a referral of the TC whenever the physician provides a PC. 24
25 What Do We Know for Certain? Anticipated referrals of DHS cannot be considered when establishing physician compensation. The amount of the compensation must reflect only the FMV of the professional services being provided. 25
26 What Remains Unanswered? Did the court properly assess if an ICA exists in the first place? Is the court reading an FMV standard into the ICA definition? Unclear whether arrangements where compensation exceeds collections always implicate the volume or value standard. If compensation is FMV, could it still potentially be deemed to take into account anticipated referrals because of the hospital s business/strategic objectives for entering into the transaction? 26
27 What Remains Unanswered? If personally performed services automatically generate a TC referral, will compensation always vary based on the volume or value of referrals? Arguably, a compensation arrangement could generate referrals of a TC, but not necessarily vary based on the volume or value of TC referrals, e.g. FMV compensation based on wrvus or professional fee collections for personally performed services. What if the physicians were bona fide full-time employees (such as cardiologists or internists) with a substantial office-based practice and only a subset of their professional services generate a corresponding TC which is DHS? 27
28 Discussion of safeguards Legal counsel; carefully structure arrangements from the outset, considering the Tuomey opinion, and the government s positions in the case. Do not tier base (or bonus) compensation. If possible, avoid part-time employment, especially in similar circumstances. Don t give full-time benefits to part-time employees. If possible, keep compensation below expected professional fees. Transaction as a whole should be commercially reasonable. Others 28
29 Questions 29
30 Let's Talk Tuomey: The Fourth Circuit's Recent Stark Analysis and Its Impact on Hospital- Physician Arrangements 2012 is published by the American Health Lawyers Association. All rights reserved. No part of this publication may be reproduced in any form except by prior written permission from the publisher. Printed in the United States of America. Any views or advice offered in this publication are those of its authors and should not be construed as the position of the American Health Lawyers Association. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is provided with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice or other expert assistance is required, the services of a competent professional person should be sought from a declaration of the American Bar Association 30
Building a Strategic Plan for Physician Employment and Practice Acquisition
Building Practice Acquisition and Physician Employment Strategies that Will Last the Test of Time In a Changing Regulatory Environment David Lewis Vice President/Associate General Counsel LifePoint Hospitals
More informationAHLA. CC. Cutting Edge Stark Issues. Julie E. Kass OBER KALER Washington, DC. David E. Matyas Epstein Becker & Green PC Washington, DC
AHLA CC. Cutting Edge Stark Issues Julie E. Kass OBER KALER Washington, DC David E. Matyas Epstein Becker & Green PC Washington, DC Institute on Medicare and Medicaid Payment Issues March 26-28, 2014 Advanced
More informationHealthcare Regulatory Issues We Wish We d Never Heard of
Healthcare Regulatory Issues We Wish We d Never Heard of Robert G. Homchick, Davis Wright Tremaine, LLP William W. Horton, Johnston Barton Proctor & Rose LLP #1 Will Tuomey Happen to Me? The problem: We
More informationI Thought FMV Was Supposed to be Bulletproof: Recent Court Decisions Involving Fair Market Value
HCCA Compliance Institute 2012 Legal & Regulatory 706 I Thought FMV Was Supposed to be Bulletproof: Recent Court Decisions Involving Fair Market Value Jeff Fitzgerald, Shareholder, Polsinelli Shughart
More information3/4/2014. Prosecuting fraud is good business. HCCA Regional Conference Physician Contracting Issues
HCCA Regional Conference Physician Contracting Issues Overview of Anti-Kickback Statute & Stark Law and Downstream Revenue Steven H. Pratt, Esq. Hall, Render, Killian, Heath & Lyman, P.C. spratt@hallrender.com
More informationPhysician Care: Physician Compensation. Presented by Albert R. Riviezzo, Esq. Fox Rothschild LLP Exton, PA
Physician Care: Physician Compensation Presented by Albert R. Riviezzo, Esq. Fox Rothschild LLP Exton, PA Overview Compensation trends for employed physicians Regulatory risks of physician compensation
More informationStark Law Dos and Don ts: Best Practices for your Physician Contracts
Stark Law Dos and Don ts: Best Practices for your Physician Contracts Robert A. Wade, Esq. Partner Krieg DeVault LLP 4101 Edison Lakes Parkway, Ste. 100 Mishawaka IN 46545 574-485-2002 bwade@kdlegal.com
More informationThe Intersection of Valuation and Physician Productivity
The Intersection of Valuation and Physician Productivity McRae Sharpe, CMPE Shareholder August 11, 2015 Shannon W. Farr, CPA/ABV/CFF Director Objectives Define Fair Market Value (FMV) and Commercial Reasonableness
More informationERISA Litigation Update for Health Plans
ERISA Litigation Update for Health Plans This roundtable discussion is brought to you by the Payors, Plans, and Managed Care (PPMC) Practice Group. May 17, 2013 12:00-1:15 pm Eastern Presenter Patrick
More informationAntitrust and ACOs: What the Antitrust Enforcement Agencies Have in Store for ACOs Tuesday, April 26, :00-2:30 pm Eastern
Antitrust and ACOs: What the Antitrust Enforcement Agencies Have in Store for ACOs Tuesday, April 26, 2011 1:00-2:30 pm Eastern This webinar is brought to you by the Antitrust Practice Group and the Accountable
More informationCOMMERCIAL REASONABLENESS AND FINANCIAL ARRANGEMENTS WITH PHYSICIANS
COMMERCIAL REASONABLENESS AND FINANCIAL ARRANGEMENTS WITH PHYSICIANS Daniel H. Melvin, Partner, McDermott Will & Emery, in consultation with Daryl Johnson, Managing Partner, Health Care Appraisers, Inc.
More informationTax Issues for P&C Actuaries
CAS Spring Meeting May 19, 2015 Colorado Springs CO Tax Issues for P&C Actuaries Richard Riley Foley & Lardner LLP Chuck Mitchell FCAS MAAA Milliman Inc. Co-presenter Sheryl Flum KPMG LLP Rich Yocius FCAS
More informationFair Market Value in Health Care Transactions
Fair Market Value in Health Care Transactions AMGA Council of Attorneys Annual Meeting October 15 18, 2013 James B. Platt, Esq. 2013 Fredrikson & Byron, P.A. Overview Laws that refer to fair market value
More information2018 PA Super 45. Appeal from the Order entered March 29, 2017 In the Court of Common Pleas of Chester County Civil Division at No: CT
2018 PA Super 45 WILLIAM SMITH SR. AND EVERGREEN MANAGEMENT GROUP, INC. IN THE SUPERIOR COURT OF PENNSYLVANIA v. BRIAN HEMPHILL AND COMMERCIAL SNOW + ICE, LLC APPEAL OF BARRY M. ROTHMAN, ESQUIRE No. 1351
More informationCompliance in Physician Employment and Hospital- Physician Integration
Compliance in Physician Employment and Hospital- Physician Integration Winn W. Halverhout Husch Blackwell LLP Barbara A. Yosses Poudre Valley Health System Husch Blackwell LLP 1 Current Integration Structures
More informationFY 2009 IPPS Rule. Recent Stark Developments. Recent Stark Developments. Edwin Rauzi Partner Davis Wright Tremaine LLP Seattle, WA
Don Romano Partner Arent Fox LLP Washington, D.C Edwin Rauzi Partner Davis Wright Tremaine LLP Seattle, WA Gadi Weinrich Partner Sonnenschein, Nath & Rosenthal LLP Washington, D.C. 1 FY 2009 IPPS Rule
More informationPHYSICIAN ALIGNMENT: LEGAL AND FAIR MARKET VALUE COMPLIANCE
PHYSICIAN ALIGNMENT: LEGAL AND FAIR MARKET VALUE COMPLIANCE Health Care Compliance Association 17 th Annual Compliance Institute April 22, 2013 Donnessa Vessakosol Strategic Value Group, LLC Cheryl Camin
More informationAHLA. U. Physician Relationship Audit Workshop: A Practical Guide to Auditing Physician Relationships and Addressing Identified Issues
AHLA U. Physician Relationship Audit Workshop: A Practical Guide to Auditing Physician Relationships and Addressing Identified Issues Bret S. Bissey Senior Vice President, Compliance Services MediTract,
More informationFAIR MARKET VALUE & COMMERCIAL REASONABLENESS
FAIR MARKET VALUE & COMMERCIAL REASONABLENESS Insight from the C-Suite August 17, 2017 Tammy Walsh Director twalsh@bkd.com Neil Giannini, CPA/ABV Senior Managing Consultant ngiannini@bkd.com Overview of
More informationDOCUMENTING FAIR MARKET VALUE & COMMERCIAL REASONABLENESS. Strategies for Success 11/8/2016. November 9, 2016
Strategies for Success DOCUMENTING FAIR MARKET VALUE & COMMERCIAL REASONABLENESS November 9, 2016 Randy Biernat, CPA/ABV Director rbiernat@bkd.com Neil Giannini, CPA/ABV Managing Consultant ngiannini@bkd.com
More informationFraud and Abuse Primer Hypotheticals
Fraud and Abuse Primer Hypotheticals Sanford V. Teplitzky S.Craig Holden William T. Mathias Ober Kaler Baltimore, Maryland PHYSICIAN RECRUITMENT HYPO Hospital A is located in a rapidly growing community
More informationN R a v e n s w o o d A v e, S t e C h i c a g o, I L w w w. a e g i s - c o m p l i a n c e.
Jorge Pérez-Casellas, JD, LLM, CHC jpcasellas@aegis-compliance.com Miglisa Capó-Suria, JD, LLM mcapo@metropaviahealth.com A Presentation for the 2017 HCCA San Juan Regional Conference May 19, 2017 / 8:30AM
More informationAuditing Physician Arrangements
Tuesday, October 24, 2017 1:00 P.M.- 2:30 P.M. Eastern Auditing Physician Arrangements Presented by: Allison Carty, JD, MBA Director Pinnacle Healthcare Consulting acarty@askphc.com Joseph N. Wolfe, Attorney/Shareholder
More informationFair Lending TILA and RESPA Integrated Disclosures ( TRID ) and Consumer Financial Protection Bureau ( CFPB )
Fair Lending TILA and RESPA Integrated Disclosures ( TRID ) and Consumer Financial Protection Bureau ( CFPB ) Presented by Anthony J. Sylvester, Esq. Craig L. Steinfeld, Esq. Sherman Wells Sylvester &
More informationCompensation Paid by Healthcare Providers
Compensation Paid by Healthcare Providers Physician compensation continues to be an especially important issue due to extensive integration of medical practices into larger healthcare systems and the severe
More informationHancock, Daniel & Johnson, P.C., P.O. Box 72050, Richmond, VA , ,
Hancock, Daniel & Johnson, P.C., P.O. Box 72050, Richmond, VA 23255-2050, 804-967-9604, www.hancockdaniel.com 2018 Hancock, Daniel & Johnson P.C. hancockdaniel.com Fraud and Abuse Enforcement 1.Anti-kickback
More informationAHLA. W. Trivial Pursuit: Stark Law Edition. Tony R. Maida McDermott Will & Emery LLP New York, NY. Catherine A. Martin Ober Kaler Baltimore, MD
AHLA W. Trivial Pursuit: Stark Law Edition Tony R. Maida McDermott Will & Emery LLP New York, NY Catherine A. Martin Ober Kaler Baltimore, MD Lisa Ohrin Wilson Senior Technical Advisor Centers for Medicare
More informationWORKING DRAFT 8/10/2016
DISCLAIMER PHYSICIAN PRACTICE LOSSES THE ELEPHANT IN THE ROOM HFMA Arkansas Chapter Summer Conference August 18, 2016 Herd Midkiff, CVA Partner Director of Consulting Services Haley Adams, CVA Senior Manager,
More informationPrepared for: Practical Advice on Physician Compensation: Achieving Compliance and FMV
Prepared for: Practical Advice on Physician Compensation: Achieving Compliance and FMV Jen Johnson, CFA Perspective: 3 rd party valuation expert with understanding of legal and compliance issues. Managing
More informationCOMPENSATING EMPLOYED PHYSICIANS Tax Law, Stark and Anti-Kickback Implications. AHLA Tax Issues for Healthcare Organizations October 20-22, 2013
AHLA B. Compensating Employed Physicians Tax Law, Stark, and Anti-Kickback Implications Linda Sauser Moroney Drinker Biddle & Reath LLP Milwaukee, WI Claire M. Turcotte Bricker & Eckler LLP West Chester,
More informationThe Compliance Officer s Role in Physician Contracting. April 11, Jim Passey Director, Compliance & Internal Audit Services Huntington Hospital
The Compliance Officer s Role in Physician Contracting April 11, 2011 Curt Chase Chair, Healthcare Dept Husch Blackwell LLP Jim Passey Director, Compliance & Internal Audit Services Huntington Hospital
More informationOhio Hospital Association 2014 Annual Meeting. Compensating Employed Physicians In An Evolving Health Care Environment
Ohio Hospital Association 2014 Annual Meeting June 10, 2014 Compensating Employed Physicians In An Evolving Health Care Environment Kimberly Mobley, Sullivan, Cotter and Associates, Inc., kimmobley@sullivancotter.com
More informationAvoiding Regulatory Land Mines in Commercial ACOs
Avoiding Regulatory Land Mines in Commercial ACOs Robert Belfort, Partner Healthcare Industry Martin Thompson, Partner Healthcare Industry Manatt, Phelps & Phillips, LLP September 30, 2014 Agenda 1 Antitrust
More informationThe Salcido Report. False Claims Act Public Disclosure Alert. If you read one thing...
The Salcido Report September 25, 2015 If you read one thing... Launch of a new False Claims Act (FCA) resource The Public Disclosure Alert (PDA) provides expert analysis of latest paradigm shifting FCA
More informationStark Update HCCA Hawaii Conference
Stark Update HCCA Hawaii Conference Steven W. Ortquist VP, Chief Ethics and Compliance Officer Today s Agenda Review of healthcare Anti-Kickback statute and Stark law and regulations Discuss implications
More information14 - Court Determines Damages for Willfully Filing a Fraudulent Information Return
14 - Court Determines Damages for Willfully Filing a Fraudulent Information Return Angelopoulo v. Keystone Orthopedic Specialists, S.C., et al., (DC IL 7/9/2018) 122 AFTR 2d 2018-5028 A district court
More informationNew Frontiers in AMC Funding: Mission Support Alternatives Post-Halifax. Thomas N. Bulleit Partner, Ropes & Gray LLP
New Frontiers in AMC Funding: Mission Support Alternatives Post-Halifax I. Introduction Thomas N. Bulleit Partner, Ropes & Gray LLP Lisa T. Wahler Associate Vice President and Deputy General Counsel Rutgers,
More informationOn this certified question from the United States Court. of Appeals for the Second Circuit, we are asked whether, under
================================================================= This opinion is uncorrected and subject to revision before publication in the New York Reports. -----------------------------------------------------------------
More informationThe Bradford Regional Medical Center Decision Implications for FMV and other Considerations For Stark and Anti-Kickback January 26, 2011
Implications for FMV and other Considerations For Stark and Anti-Kickback January 26, 2011 Donald H. Romano Romano.donald@arentfox.com 202-715-8407 Arent Fox LLP 1050 Connecticut Ave., NW Washington, DC
More informationInvestigator Compensation: Motivation vs. Regulatory Compliance
Vol. 12, No. 9, September 2016 Happy Trials to You Investigator Compensation: Motivation vs. Regulatory Compliance By Payal Cramer Physician-investigators play a central role in clinical research. Through
More informationThe Impact of Emerging Reimbursement Models on Physician Compensation
The Impact of Emerging Reimbursement Models on Physician Compensation By: Beth Connor Guest, Chief Counsel, Cigna HealthSpring and Patricia O. Powers, Office of General Counsel, Vanderbilt University.
More informationa publication of the health care compliance association MARCH 2018
hcca-info.org Compliance TODAY a publication of the health care compliance association MARCH 2018 On improv and improving communication an interview with Alan Alda This article, published in Compliance
More informationHospital Incentive Payments to Physicians for Quality and Cost Savings
Hospital Incentive Payments to Physicians for Quality and Cost Savings Implications under the Fraud and Abuse Laws March 1, 2011 Dennis S. Diaz Davis Wright Tremaine LLP dennisdiaz@dwt.com 213-633-6876
More informationAHLA. G. Recent Developments in Stark and AKS Jurisprudence. S. Craig Holden OBER KALER Baltimore, MD
AHLA G. Recent Developments in Stark and AKS Jurisprudence S. Craig Holden OBER KALER Baltimore, MD Kevin G. McAnaney Law Offices of Kevin McAnaney Washington, DC Fraud and Compliance Forum October 6-7,
More informationFundamentals and Practicalities of Identifying and Returning Overpayments
Fundamentals and Practicalities of Identifying and Returning Overpayments American Health Lawyers Association Physicians and Physician Organizations Law Institute Hospitals and Health Systems Law Institute
More informationUpper Tribunal (Immigration and Asylum Chamber) PA/02086/2017 THE IMMIGRATION ACTS
Upper Tribunal (Immigration and Asylum Chamber) PA/02086/2017 Appeal Number: THE IMMIGRATION ACTS Heard at Manchester Decision & Reasons Promulgated On 23 October 2017 On 25 October 2017 Before Deputy
More informationThe PPACA's Summary of Benefits and Coverage: What Do the Final Rules Mean for Insurers and Self- Funded Employers?
The PPACA's Summary of Benefits and Coverage: What Do the Final Rules Mean for Insurers and Self- Funded Employers? This roundtable discussion is brought to you by the Health Plan Affinity Group (HP AG)
More informationFRAUD AND ABUSE LAW IMPLICATED BY COMPENSATION ARRANGEMENTS. Lee Rosebush, PharmD, RPh, MBA, JD
FRAUD AND ABUSE LAW IMPLICATED BY COMPENSATION ARRANGEMENTS Lee Rosebush, PharmD, RPh, MBA, JD lrosebush@bakerlaw.com Real Quick Overview False Claims Act Any person who knowingly presents, or causes to
More informationImpact of Stark II, Phase II Regulations on Existing and Future Hospital/Physician Arrangements
Impact of Stark II, Phase II Regulations on Existing and Future Hospital/Physician Arrangements Health Care Provider Legal Issues Program WHA Annual Convention September 16, 2004 Michael Skindrud Godfrey
More informationPHYSICIAN INVESTMENT COMPLIANCE
PHYSICIAN INVESTMENT COMPLIANCE Dr. NICK OBERHEIDEN LYNETTE BYRD 1-800-810-0259 Available on Weekends page 1 INTRODUCTION Many physicians are tempted to develop income from ancillary services. While there
More informationAmerican Academy of Orthopaedic Surgeons 2010 Annual Meeting. March 12, 2010
American Academy of Orthopaedic Surgeons 2010 Annual Meeting March 12, 2010 Developments in the Evolving Orthopaedic Surgeon - Industry Relationship Kathleen McDermott, Esquire Washington, DC 1 Developments
More informationNOTICE OF CLASS ACTION SETTLEMENT
NOTICE OF CLASS ACTION SETTLEMENT TO: ALL PERSONS WHO, AT ANY TIME AFTER JULY 31, 2003, WERE AWARDED BENEFITS UNDER SAIA MOTOR FREIGHT LINE, LLC S LONG-TERM DISABILITY PLAN THAT WERE REDUCED BASED ON A
More informationAnti Kickback Statute Update By Meredith Williams
Kickback and Stark Law Developments HCCA 20 th Annual Compliance Institute April 17 20, 2016 Meredith Williams Senior Counsel Office of Inspector General, DHHS Washington, DC Robert A. Wade Partner Krieg
More informationWhy Physicians and Physician Organizations Should be Concerned about Stark Compliance
Why Physicians and Physician Organizations Should be Concerned about Stark Compliance Steven W. Ortquist Partner, Aegis Compliance & Ethics Center, LLP 1 Introduction What do the Stark Statute and the
More information7/25/2018. Government Enforcement in the Clinical Laboratory Space. The Statutes & Regulations. The Stark Law. The Stark Law.
Government Enforcement in the Clinical Laboratory Space 2 SCOTT R. GRUBMAN, ESQ. The Statutes & Regulations 3 4 AKA the physician self-referral law The Rule: If physician (or immediate family member) has
More informationAHLA. X. Fundamentals of Health Care Valuation for Health Lawyers and Compliance Officers
AHLA X. Fundamentals of Health Care Valuation for Health Lawyers and Compliance Officers Albert D. Hutzler, IV HealthCare Appraisers Inc Delray Beach, FL Joseph N. Wolfe Hall Render Killian Heath & Lyman
More informationStark Prevention A Practical Approach to Physician Transactions. Paul Belton, VP Corporate Compliance Sharp Healthcare
Stark Prevention A Practical Approach to Physician Transactions. Paul Belton, VP Corporate Compliance Sharp Healthcare Dwight Claustre Health Care Compliance Professional 1 Objectives A practical non-attorney
More informationUnited States Court of Appeals
In the United States Court of Appeals For the Seventh Circuit No. 15 2516 RONALD OLIVA, Plaintiff Appellant, v. BLATT, HASENMILLER, LEIBSKER & MOORE, LLC, Defendant Appellee. Appeal from the United States
More informationTuesday, April 16, :00-2:15 pm Eastern. Presenters. Melissa Markey, Esquire Hall Render Killian Heath & Lyman PC Troy, MI
HITECH Final Omnibus Rule Bootcamp Webinar and Roundtable Discussion Series, Part VI: Academic Medicine, Research, and Life Sciences Perspectives on the HITECH Final Omnibus Rule This bootcamp webinar
More informationCo-Management Arrangements and Their Continuing Evolution Trends Issues Fair Market Value
Co-Management Arrangements and Their Continuing Evolution Trends Issues Fair Market Value Presented by: Gregory D. Anderson, CPA/ABV, CVA HORNE LLP 601.268.1040 greg.anderson@horne-llp.com Ann S. Brandt,
More informationCoding Partners in Patient Safety
Coding Partners in Patient Safety Senior Loss Prevention Attorney UF Self Insurance Programs Learning Objectives Understand federal fraud and abuse laws and the importance of coders in avoiding issues.
More informationProposed ACO Rule: How Will It Affect Academic Medical Centers?
Proposed ACO Rule: How Will It Affect Academic Medical Centers? This roundtable discussion is brought to you by the Teaching Hospitals and Academic Medical Centers Practice Group Wednesday, May 25, 2011
More informationRecent Developments In Voluntary Disclosure Stark Law
HCCA Compliance Institute 2010 Legal & Regulatory W6, Part1 April 21, 2010 Recent Developments In Voluntary Disclosure Stark Law Jeffrey Fitzgerald Faegre & Benson LLP jfitgerald@faegre.com 303.607.3740
More informationDeciphering the Self-Disclosure Puzzle
Deciphering the Self-Disclosure Puzzle ABA Health Law Section Emerging Issues in Healthcare Law Bill Mathias 410.347.7667 wtmathias@ober.com Lisa Ohrin 410.786.8852 Lisa.Ohrin1@cms.hhs.gov February 28,
More informationPhysician Relationship Compliance Issues
Physician Relationship Compliance Issues Charles Oppenheim Hooper, Lundy & Bookman, PC Overview of Anti-Kickback Statute It is a federal crime to: Knowingly and willfully offer or pay/solicit or receive
More informationPhysician Relationship Compliance Issues. Charles Oppenheim Hooper, Lundy & Bookman, PC
Physician Relationship Compliance Issues Charles Oppenheim Hooper, Lundy & Bookman, PC Overview of Anti-Kickback Statute It is a federal crime to: Knowingly and willfully offer or pay/solicit or receive
More informationPHASE II OF THE FINAL STARK REGULATIONS: WHAT DO THEY MEAN FOR HEALTHCARE PROVIDERS
Kean Miller Health Care Industry Business Group PHASE II OF THE FINAL STARK REGULATIONS: WHAT DO THEY MEAN FOR HEALTHCARE PROVIDERS April 28, 2004 Linda G. Rodrigue, Esq. and Clay J. Countryman, Esq. Kean,
More informationBogies: Federal Anti- Kickback Law & EMS Contracting - Emerging Issues Pamela L. Johnston Foley & Lardner LLP Partner, Los Angeles.
Bogies: Federal Anti- Kickback Law & EMS Contracting - Emerging Issues Pamela L. Johnston Foley & Lardner LLP Partner, Los Angeles May 2018 Agenda Big Picture Quick Refresher on the AKS Emerging Issues
More information21 - CA 10 Clarifies TEFRA Partnership Audit SOL and Trial Court Jurisdiction. Omega Forex Group LC et al., (CA 10 10/22/2018) 122 AFTR 2d
21 - CA 10 Clarifies TEFRA Partnership Audit SOL and Trial Court Jurisdiction Omega Forex Group LC et al., (CA 10 10/22/2018) 122 AFTR 2d 2018-5350 The Court of Appeals for the Tenth Circuit, affirming
More informationFundamentals of Healthcare Valuation for Health Lawyers and Compliance Officers
Fundamentals of Healthcare Valuation for Health Lawyers and Compliance Officers Theresa Carnegie, Esq. Albert Chip Hutzler, JD, MBA, CVA AHLA/HCCA Fraud and Compliance Forum September 30, 2013 1 Agenda:
More informationTNT Law Group, LLC (Team 22) Recommendations on Due Diligence Findings: Transaction Between Pearson & Caring Health Systems
: Transaction Between Pearson & Caring Health Systems (Team 22) 123 N. Washington Ave., Suite 400 Beazley, Loyola 12345 Phone: (333) 122-4566 Fax: (333) 122-6677 Email: team22@tntlawgroup.com TABLE OF
More informationStructuring Specialty Pharmacy Distribution Arrangements in a Turbulent Regulatory Environment Mini Summit XVIII
Structuring Specialty Pharmacy Distribution Arrangements in a Turbulent Regulatory Environment Mini Summit XVIII The 16 th Pharmaceutical Compliance Congress and Best Practices Forum Thursday, October
More informationFundamentals of Healthcare Valuation for Health Lawyers and Compliance Officers
Fundamentals of Healthcare Valuation for Health Lawyers and Compliance Officers Joseph Wolfe, Esq. Albert Chip Hutzler, JD, MBA, CVA AHLA Fraud and Compliance Forum October 7, 2014 1 Agenda: Why Fair Market
More informationLessons Learned from Recent Enforcement Actions
Developing Compliant Physician Compensation Arrangements in the Current Enforcement Environment Anna M. Grizzle Bass, Berry & Sims PLC Lessons Learned from Recent Enforcement Actions 1 Physician Remuneration
More informationPennsylvania Bar Institute
Pennsylvania Bar Institute 24 th Annual Health Law Institute Physician Year In Review MARCH 13, 2018 Charles I. Artz, Esq. Artz McCarrie Health Law I. STARK/FALSE CLAIMS ACT VIOLATION $20.75 MILLION RECOVERY
More informationOIG Enforcement Initiatives Relating to Hospitals. Outline of Presentation
OIG Enforcement Initiatives Relating to Hospitals S. Craig Holden Ober Kaler 1 Lew Morris Adelman Scheff & Smith,LLP Outline of Presentation 2013 OIG Work Plan Issues for Hospitals Trends in Individual
More informationFederal Fraud and Abuse Enforcement in the ASC Space
Federal Fraud and Abuse Enforcement in the ASC Space SCOTT R. GRUBMAN, ESQ. PARTNER CHILIVIS COCHRAN LARKINS & BEVER, LLP (ATLANTA GA) Fraud & Abuse Enforcement Landscape FBI CMS OCR MFCU DCIS DOJ HHS-OIG
More informationFINAL ORDER AFFIRMING TRIAL COURT. the trial court s Final Judgment entered July 16, 2014, in favor of Appellee, Emergency
IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT, IN AND FOR ORANGE COUNTY, FLORIDA PROGRESSIVE AMERICAN INSURANCE COMPANY, CASE NO.: 2014-CV-000054-A-O Lower Case No.: 2011-SC-008737-O Appellant, v.
More informationCalculation and Conclusion of Value and Other Roles Valuators Play
Current Update in Valuations Calculation and Conclusion of Value and Other Roles Valuators Play Marc Bello Courtney Sparks White Please set pagers, cell phones, etc. on vibrate mode or turn them off. Please
More informationCircuit Court for Baltimore City Case No UNREPORTED IN THE COURT OF SPECIAL APPEALS OF MARYLAND. No September Term, 2017
Circuit Court for Baltimore City Case No. 17502127 UNREPORTED IN THE COURT OF SPECIAL APPEALS OF MARYLAND No. 1189 September Term, 2017 ANTHONY GRANDISON v. STATE OF MARYLAND Woodward, C.J., Fader, Zarnoch,
More informationConflicts of Interest 9/10/2017. Everything a Health Care Executive Needs to Know about the Anti-Kickback Statute. May 2, 2017 Article from JAMA:
Everything a Health Care Executive Needs to Know about the Anti-Kickback Statute Matthew Krueger Assistant United States Attorney E.D. of Wisconsin Stacy Gerber Ward von Briesen & Roper, S.C. Conflicts
More informationACC Quik Hit. Roger Strode Foley-Chicago, IL. April 5, 2016
ACC Quik Hit Roger Strode Foley-Chicago, IL April 5, 2016 Attorney Advertising Prior results do not guarantee a similar outcome Models used are not clients but may be representative of clients 321 N. Clark
More informationPhysician Rockstars Toolkit - Common Models and Legal Considerations for Securing the Services of Rockstar physicians. Item 3
(1) Employment Agreements Stark Exception Requirements 1 42 U.S.C. 1395nn(e)(2)/ 42 CFR 411.357(c) There is a bona fide employment relationship and the employment is for identifiable services. The amount
More information2012 Health Law Education Program: Anatomy of a Self- Disclosure Telling CMS About Your Stark Law Problems
2012 Health Law Education Program: Anatomy of a Self- Disclosure Telling CMS About Your Stark Law Problems October 24, 2012 12:00 p.m. 1:00 p.m. Central Web Seminar Continuing Education Information We
More informationProvider and Provider Relationships. Primary Fraud and Abuse Issues
Provider and Provider Relationships Primary Fraud and Abuse Issues This document is intended to identify the primary healthcare fraud and abuse laws that may apply to contractual relationships between
More informationUNDERSTANDING AND WORKING WITH THE LATEST STARK LAW DEVELOPMENTS
26 th Annual National CLE Conference Law Education Institute January 3-7, 3 2009 UNDERSTANDING AND WORKING WITH THE LATEST STARK LAW DEVELOPMENTS By JONELL B. WILLIAMSON January 5, 2009 1 Stark Prohibition
More information3/22/2016 THE STARK TRIFECTA. How Legal, Compliance, and Outside Counsel Work Together on Stark Compliance
THE STARK TRIFECTA How Legal, Compliance, and Outside Counsel Work Together on Stark Compliance 1 1. Understand the risks posed by any financial relationship between a hospital and a physician group, and
More information2014 Lathrop & Gage LLP Lathrop & Gage LLP Lathrop & Gage LLP
Legal Issues for Physician Owned Implant Manufacturer/Distribution Companies (PODs) October 24, 2014 Randal L. Schultz, Esq. 10851 Mastin Blvd, Building 82, Suite 1000 Overland Park, KS 66210-1669 913.451.5192
More informationUNPUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT. No
UNPUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 13-4490 UNITED STATES OF AMERICA, Plaintiff - Appellee, v. ROBERT FENN, Defendant Appellant. Appeal from the United States District
More informationThis webinar is sponsored by the Fraud and Abuse Practice Group.
Trends in Health Care Enforcement: Past, Present, and Future July 21, 2014 3:30-4:45 Eastern This webinar is sponsored by the Fraud and Abuse Practice Group. Faculty : Susan Winkler Assistant U.S. Attorney,
More informationFair Market Value and Commercial Reasonableness: Physician Compensation Agreements
and : Physician Agreements Webinar By: Todd A. Zigrang, MBA, MHA, FACHE, ASA President HEALTH CAPITAL CONSULTANTS December 18, 2013 1 About the Presenter Todd A. Zigrang, MBA, MHA, ASA, FACHE, is the President
More informationIN THE COURT OF APPEALS OF OHIO SIXTH APPELLATE DISTRICT OTTAWA COUNTY. Trial Court No. 91-DR-213A * * * * * * * * * *
[Cite as Osting v. Osting, 2009-Ohio-2936.] IN THE COURT OF APPEALS OF OHIO SIXTH APPELLATE DISTRICT OTTAWA COUNTY Nancy M. Osting Appellee Court of Appeals No. OT-07-033 Trial Court No. 91-DR-213A v.
More informationDISTRICT COURT OF APPEAL OF THE STATE OF FLORIDA FOURTH DISTRICT January Term 2008
DISTRICT COURT OF APPEAL OF THE STATE OF FLORIDA FOURTH DISTRICT January Term 2008 LAURI F. PARKER and CASSIE DANIELE PARKER, Appellants, v. STEVEN J. SHULLMAN, as Trustee of the PAUL SILBERMAN MARITAL
More informationAHLA. A. Stark Law Primer. Troy A. Barsky Crowell & Moring LLP Washington, DC
AHLA A. Stark Law Primer Troy A. Barsky Crowell & Moring LLP Washington, DC Joan P. Dailey Office of the General Counsel US Department of Health and Human Services Washington, DC Fraud and Compliance Forum
More informationTAUGHT BY EXPERTS: WHAT THE EXPERT TESTIMONY IN TUOMEY AND HALIFAX TELLS US ABOUT PHYSICIAN TRANSACTIONS TODAY
AMERICAN HEALTH LAWYERS ASSOCIATION 2015 FRAUD AND COMPLIANCE FORUM TAUGHT BY EXPERTS: WHAT THE EXPERT TESTIMONY IN TUOMEY AND HALIFAX TELLS US ABOUT PHYSICIAN TRANSACTIONS TODAY THE COMMERCIAL REASONABLENESS
More informationUnderstanding The Regulations Impacting Physician Arrangements AVOIDING STARK, FALSE CLAIMS ACT AND ANTI-KICKBACK VIOLATIONS
ASCC Year In Review Understanding The Regulations Impacting Physician Arrangements AVOIDING STARK, FALSE CLAIMS ACT AND ANTI-KICKBACK VIOLATIONS Presentation Regulatory Complexity Medicare Financial Data
More informationWashington Update (which includes Baltimore) for the MaineCare & Regulatory Update HFMA Maine Chapter November 19, 2015 John VanLonkhuyzen Verrill
Washington Update (which includes Baltimore) for the MaineCare & Regulatory Update HFMA Maine Chapter November 19, 2015 John VanLonkhuyzen Verrill Dana LLP Topics 2014-15 Retrospective False Claims Act
More informationWhat s On Tap? Who Are the Players? 4/3/2017. Healthcare Enforcement Trends What To Do When the Government Comes Knocking?
Healthcare Enforcement Trends What To Do When the Government Comes Knocking? Holly Logan Craig Sieverding 1 What s On Tap? Enforcement landscape, generally Fraud and Abuse Update o Brief primer on major
More informationGainsharing Is it Still Feasible? May 14, 2010
7 th Annual Illinois Chapter ACC Practice Management Symposium Gainsharing Is it Still Feasible? May 14, 2010 W. Kenneth Davis, Jr. Partner Katten Muchin Rosenman LLP 525 W. Monroe Chicago, Illinois 312.902.5573
More informationIN THE COURT OF APPEALS OF TENNESSEE AT NASHVILLE January 27, 2015 Session
IN THE COURT OF APPEALS OF TENNESSEE AT NASHVILLE January 27, 2015 Session WILLIAM C. KERST, ET AL. V. UPPER CUMBERLAND RENTAL AND SALES, LLC Appeal from the Chancery Court for Putnam County No. 200749
More information