NEGOTIATING PHYSICIAN EMPLOYMENT AGREEMENTS KEY PROVISIONS. 1. Can t limit a physician s independent medical judgment
|
|
- Derek Holt
- 5 years ago
- Views:
Transcription
1 350 Ryman Street P.O. Box 7909 Missoula, Montana (406) Fax (406) NEGOTIATING PHYSICIAN EMPLOYMENT AGREEMENTS KEY PROVISIONS I. GENERAL A. Most contract terms are negotiable B. Some are non-negotiable 1. Can t limit a physician s independent medical judgment 2. ADA 3. Discrimination provisions 4. HIPPA/HITECH (Patient Privacy) 5. In Montana, an employer can t include a contractual right to terminate an employee without cause if the employer wants the contract to be one for a specific term and thus be exempt from the Montana Wrongful Discharge From Employment Act ( WDEA ) C. Before negotiating a contract, do your homework 1. Reputation of employer 2. Interview other physician employees 3. Practice size 4. Doctor/Patient ratios in the region 5. General compensation rates in the region 6. Call coverage requirements 7. Criteria for productivity bonuses 8. Culture II. KEY PROVISIONS A. Preconditions to Employment (need to be satisfied as of the date employment commences)
2 B. Term 1. Licensed in the State 2. Hospital staff privileges 3. Board eligible or Board certified 4. Enrolled with Medicare/Medicaid 5. DEA registration 6. Provider Identification Number 7. Background check a. criminal and drug testing 8. Insurance/Insurability 1. Specific/Finite a. e.g. expires after 1 year unless both parties renew or extend b. A specific term is used to comply with the WDEA 2. Self-Perpetuating ( Evergreen ) a. Automatically renews every year if neither party gives notice of termination b. Employers can t do this if they want to be exempt from the WDEA in Montana 3. Notice to terminate without cause C. Job Description a. e.g. 90 days b. Both parties/reciprocal? c. Same notice period? d. Remember, an employer can t terminate without cause and still be exempt from the WDEA 1. Full-time 2. Part-time
3 3. Detailed job description 4. Hours and schedule 5. Required meeting attendance 6. Employee must follow office policies D. Office Location a. request and read all policies in advance b. Administrative duties? c. Marketing/outreach duties d. Supervision of mid-levels e. Expectation on number of patient visits/surgery days f. Standards of practice 1. Try to identify specific clinical office locations and other facilities where physician will work a. mileage limitation? 2. Work location will change only with mutual agreement E. Call Coverage 1. All call coverage requirements should be detailed a. e.g. office/practice call and town call 2. Schedule a. weekday, weekend, evening, holiday requirements (e.g. 1:4) 3. Call should be shared in a fair equal or equitable manner among physicians within a similar practice area or specialty 4. Will employer pay for call or call in excess of minimum requirement? F. Exclusivity 1. Must all clinical services be performed exclusively for the employer? a. Exceptions should be clearly outlined, e.g.: i. Research at University
4 i iv. Expert witness testimony Lecturing Sports team physician 2. There should be a clear approval process for how to get approval for moonlighting and who is entitled to the income G. Non-Compete Restrictive Covenant 1. Non-compete clauses are generally not favored in Montana 2. Can be enforceable in an employment arrangement if all terms are reasonable a. Duration i. 1-3 years b. Geographic Scope i. limited to the city/county and cities/counties adjacent to the city/county where the physician works not a blanket restriction on the whole or a large portion of the state c. Restricted activity is clearly stated i. e.g. practice of medicine or a specialty d. Liquidated Damages i. Must be reasonable in amount 1) e.g. one year s salary/revenues payable to the employer Must be payable over a reasonable pay period e. Injunctive relief 1) e.g months with reasonable interest rate i. may be difficult to enjoin someone from working in Montana liquidated damages are preferred 3. Maybe should not apply if the employer terminates the employee without cause 4. A covenant is not permitted under federal regulations if there is an agreement with a hospital to help recruit a physician to an existing group practice
5 H. Termination Rights 1. Do the parties want without cause termination rights? a. e.g. 90 day notice 2. Employer can t terminate without cause if it wants an exemption for a specific term contract under the WDEA 3. The parties should be able to terminate by mutual written agreement 4. Both parties should be able to terminate for good cause 5. Physician can be terminated for the following good cause reasons: a. Death b. Extended disability c. Becomes uninsurable d. Criminal conviction e. Breach of ethics f. Loss of license, DEA registration, or privileges g. Loss of Board certification h. Substance abuse i. General neglect of professional responsibility/duties j. Gross misconduct, fraud or embezzlement k. Causing patient safety issues l. Breach of employer s policies m. Failure to work cooperatively with staff, other physicians, or families n. Disbarment from any federal or state payer program o. Other breach of a material term of the agreement 6. Generally, there will be a notice and right to cure a. e.g. 30 days to cure a breach b. although some are automatic (e.g. death or loss of license)
6 7. Use of a committee of peers or an outside reviewer to review breaches can often be useful and fair (e.g. was there a breach of ethics or office policy?) I. Compensation 1. Factors that Influence Compensation a. Geographic location b. Population/demographics c. Doctor/patient ratios d. Employer i. e.g. hospital v. private practice e. Size of hospital, clinic or group f. Fellowship training g. Board Certification h. Specialty 2. Remember, both Stark and Anti-kickback (AKS) require compensation to be in a range of fair market value ( FMV ) 3. Compensation in excess of FMV can be considered to be payment for referrals and can expose both the employer and the physician to significant penalties a. e.g. fines, exclusion from Medicare or even imprisonment for a knowing violation 4. Stark has an exception and AKS has a safe harbor for bona fide employment arrangements where compensation is reasonable and based on FMV 5. Generally compensation and compensation formulas are negotiable, but always subject to a cap dictated by FMV 6. All compensation terms, including any bonus or incentive bonus formulas, should be detailed, clear and understandable 7. To the extent possible, all criteria for productivity bonuses should be based on reasonable, fair, objective, and identifiable factors that are set in advance 8. CURRENT MODELS --- PRODUCTIVITY
7 a. The current prevailing model of compensation has for years been based on productivity and volume i. straight salary income based on production (pure production) 1) billing/collections or RVUs i minimum guaranteed salary plus bonus based on level of production b. There has been a real trend to shift away from straight salary or salary guarantees to pure production models c. Productivity based compensation continues to dominate the market 9. FUTURE MODELS -- VALUE a. Policy makers in Washington DC and elsewhere have concluded that fee-forservice reimbursement and production based compensation models have incentivized physicians to emphasize volume, which can lead to overutilization and sometimes can fail to adequately factor in quality of care/outcomes b. So as a result of the ACA and other pressures, payers are moving toward an emphasis on value based factors: i. patient satisfaction/citizenship criteria i iv. use of EHR quality metrics outcomes v. cost savings c. However, some of these factors are subjective and difficult to evaluate in a fair, consistent, and objective way, so have been difficult to evaluate d. Data metrics are being developed to help measure value e. Until we get a fair and consistent way to measure value, the transition to valuebased compensation will be slow f. The pendulum may swing to value-based compensation and incentives as effective metrics are developed. g. Ultimately, as a practical matter, future models will have to find a balance that creates incentives for physicians to produce both volume and value i. Example
8 J. Insurance ) Current model: $40 per w RVU Plus physician is eligible for a $15,000 quality bonus based on patient satisfaction and timely charting 2) Future model: $25 w RVU guaranteed Plus $15 per w RVU available based on value-based incentive pool for meeting minimum patient satisfaction, quality and outcome metrics/standards Plus a $5 per w RVU employer incentive pool for meeting superlative standards for a particular metric h. The future model creates incentive for physicians to produce both volume and value i. Physicians who produce merely high volume, would see reductions in income j. Physicians who produce a high level of value under the value-based metrics, may see comparable or an increase in income k. The success of implementing such a future model is dependent on being able to measure value-based factors objectively and consistently l. This will be an ongoing process. Ultimately we will see a balanced compensation system with 25-50% of income based on value-based metrics 1. Address professional liability insurance obligations 2. Nose coverage a. prior acts 3. Practice coverage a. occurrence or claims made 4. Tail coverage a. extended reporting endorsement 5. Who pays? a. Nose i. generally physician b. Practice i. generally employer
9 c. Tail i. negotiable K. Benefits 1. Clearly outline all benefits a. Health and disability insurance b. Retirement c. PTO i. vacation, sick leave, CME d. CME reimbursement e. Dues & subscriptions f. Moving expenses g. Sign on bonus h. Maternity L. Miscellaneous 1. Indemnity 2. Confidentiality 3. Arbitration/Attorney s Fees 4. Supervision 5. Performance reviews 6. Physician s future rights to purchase an equity interest in the group practice 7. Facilities and equipment provided by the employer 8. Revise/review compensation to help assure FMV 9. Regulatory savings clause Gary B. Chumrau
Representing Physicians: Potential Perils & Pitfalls: Life Cycle of a Physician- Practice
Representing Physicians: Potential Perils & Pitfalls: Life Cycle of a Physician- Practice A Presentation For: American Health Lawyers Association Fundamentals of Health Law Chicago November 13-15, 15,
More informationTIPS FOR NEGOTIATING PHYSICIAN EMPLOYMENT AGREEMENTS Basic Clauses and Considerations
TIPS FOR NEGOTIATING PHYSICIAN EMPLOYMENT AGREEMENTS Basic Clauses and Considerations Presented by: www.thehealthlawfirm.com Main Office: 1101 Douglas Avenue Altamonte Springs, FL 32714 Phone: (407) 331-6620
More informationRepresenting Physicians Primer
Representing Physicians Primer ire Cycle or a Physician-Practice Association A Presentation For: Physicians & Physician Organizations Orlando, Florida February 13,2008. Michael F. Schaff, Esq. 1 OVERVIEJJ
More informationPhysician Employment Agreements
Physician Employment Agreements Presented by Stephanie Eckerle and Ashley Osak Steps to Take Prior to Negotiating an Agreement: Employer Due Diligence References Education/Training Licensure Interviews
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 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 informationSteps To Take When Closing Your Practice
Steps To Take When Closing Your Practice Oklahoma State Medical Association Cori H. Loomis, JD Winter 2017 Overview of Relocating and Closing an Office Possible Issues During Relocation or Close What to
More informationStark Law Exceptions and Anti-Kickback Safe Harbors
Law Exceptions and Safe Harbors Price Reductions Offered to Health Plans [No comparable exception] Safe harbor for a reduction in price a contract health care provider offers to a health plan for the sole
More informationTHE PHYSICIAN EMPLOYMENT AGREEMENT Basic Clauses and Considerations DELIVERED AT FLORIDA HOSPITAL EAST ORLANDO 12/5/2012
THE PHYSICIAN EMPLOYMENT AGREEMENT Basic Clauses and Considerations by George F. Indest III Board Certified In Health Law By The Florida Bar Lance O. Leider Danielle M. Murray THE HEALTH LAW FIRM 1101
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 informationLEGAL ISSUES FOR MEDICAL RESIDENTS
LEGAL ISSUES FOR MEDICAL RESIDENTS Presented by: www.thehealthlawfirm.com Copyright 2017. George F. Indest III. All rights reserved. George F. Indest III, J.D., M.P.A., LL.M. Board Certified by the Florida
More informationCheck Your Physician Contracts
Check Your Physician Contracts Publication 1/8/2014 Kim Stanger Partner 208.383.3913 Boise kcstanger@hollandhart.com Contracts and other financial arrangements with physicians and certain other healthcare
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 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 informationProvider Networks. March 3, 2016 Gabriel Hamilton
Provider Networks March 3, 2016 Gabriel Hamilton gahamilton@hollandhart.com Area of Rapid Change Experience of commercial payers in the health insurance exchange market Medicare experiments with ACOs and
More informationD E B R A S C H U C H E R T, C O M P L I A N C E O F F I C E R
D E B R A S C H U C H E R T, C O M P L I A N C E O F F I C E R INTEGRATED CARE ALLIANCE, LLC CORPORATE COMPLIANCE PROGRAM It is the policy of Integrated Care Alliance to comply with all laws governing
More informationPhysician Contracts GOVERNANCE THOUGHT LEADERSHIP SERIES
Providing education, resources, leadership development to inspire excellence in health care governance. Hospitals regularly contract for many products and services ranging from the linens used in patient
More information4/1/2014. Proof of Intent is Not Required
Robert A. Wade, Esq. Krieg DeVault LLP 4101 Edison Lakes Parkway, Ste. 100 Mishawaka, IN 46545 Phone: 574-485-2002 Email: bwade@kdlegal.com Kevin McAnaney, Esq. Law Office of Kevin G. McAnaney 1800 K Street,
More informationWHAT EVERY NEW PRACTITIONER SHOULD CONSIDER
WHAT EVERY NEW PRACTITIONER SHOULD CONSIDER January 24, 2017 Andrew N. Meyercord Gray Reed & McGraw 1601 Elm Street Suite 4600 Dallas, Texas 75201 214.954.4135 ameyercord@grayreed.com 129 attorneys Full-service,
More informationBuilding 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 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 informationAnti-Kickback Statute Jess Smith
Anti-Kickback Statute Jess Smith Overview 1972 - Enacted 1977 - Violation became a felony 1996 - Expanded to include all Federal Health Care Programs 2009 - Health Care Fraud Prevention and Enforcement
More informationStructuring Provisions in Physician Recruitment and Employment Agreements
Presenting a live 90-minute webinar with interactive Q&A Structuring Provisions in Physician Recruitment and Employment Agreements Avoiding Stark Law and Anti-Kickback Violations and Overcoming Restrictive
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 informationImplications of Health Care Reform for Physician Compensation
Sullivan, Cotter and Associates, Inc. 612.294.3645 tomdobosenski@sullivancotter.com 2013 Sullivan, Cotter and Associates, Inc. The material may not be reproduced or copied without written consent of SullivanCotter.
More informationManaging Financial Interests: The Anti Kickback Statute (AKS)
Managing Financial Interests: The Anti Kickback Statute (AKS) Board of Commissioners Meeting February 15, 2012 Presented by: Mic Sager, Compliance Officer Context: Business Transactions o Health Care is
More informationPresenting a live 90 minute webinar with interactive Q&A. Td Today s faculty features:
Presenting a live 90 minute webinar with interactive Q&A Drafting Physician Recruitment and Employment Agreements Complying With Stark Law and Anti Kickback Laws, Addressing Restrictive Covenant Issues,
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 informationPhysician Contracts & Asset Protection
Physician Contracts & Asset Protection 1 2 3 4 5 6 7 Introduction Contracting basics Identify the contract Read the contract Understand the contract Don t dismiss boilerplate Ask for changes Employment
More informationMedicare Parts C & D Fraud, Waste, and Abuse Training and General Compliance Training
Medicare Parts C & D Fraud, Waste, and Abuse Training and General Compliance Training Developed by the Centers for Medicare & Medicaid Services Issued: February, 2013 Important Notice This training module
More informationTop 10 Issues in APM Contract Negotiations
Legal Issues in New Contracting and Risk Sharing Models - What To Know Before You Sign Alexis Finkelberg Bortniker Foley & Lardner LLP 617-226-3177 Abortniker@foley.com June 2, 2017 Top 10 Issues in APM
More informationDeveloped by the Centers for Medicare & Medicaid Services Issued: February, 2013
Medicare Parts C & D Fraud, Waste, and Abuse Training and General Compliance Training Developed by the Centers for Medicare & Medicaid Services Issued: February, 2013 Important Notice This training module
More informationIDN Goals (cont d) Integrated Delivery Networks and What They Mean for Compliance. Integrated Delivery Network (IDN) Goals
Integrated Delivery Networks and What They Mean for Compliance Chris Rossman, Esq. Foley & Lardner LLP Detroit, Michigan Attorney Advertising Prior results do not guarantee a similar outcome Models used
More informationPhysician Lease Arrangements: New Rules
Physician Lease Arrangements: New Rules Presented by: Roger Clayton Peoria Office rclayton@heylroyster.com Greg Rastatter Peoria Office grastatter@heylroyster.com Tyler Robinson Springfield Office trobinson@heylroyster.com
More informationUnderstanding and Effectively Negotiating Contracts
Understanding and Effectively Negotiating Contracts Stephen K. Phillips Principal Hooper, Lundy & Bookman, P.C. 1 Los Angeles San Francisco San Diego Washington D.C. What is a Contract? An enforceable
More informationContracting with Specialty Pharmacies and Hubs 17 th Annual Pharma and Medical Device Compliance Congress. October 20, 2016
Contracting with Specialty Pharmacies and Hubs 17 th Annual Pharma and Medical Device Compliance Congress October 20, 2016 Thomas Beimers Hogan Lovells Thomas.beimers@hoganlovells.com Sarah Franklin Covington
More informationMANAGING HOME HEALTH AND HOSPICE REGULATORY RISK IN THE NEW HEALTH CARE ECONOMY
MANAGING HOME HEALTH AND HOSPICE REGULATORY RISK IN THE NEW HEALTH CARE ECONOMY By: Thomas William Baker, Esq. Baker Donelson Bearman Caldwell & Berkowitz, PC (404) 221-6510 (Phone) (404) 238-9640 (Facsimile)
More informationThere is nothing wrong with change, if it is in the right direction Winston Churchil
Changes Changes 2012 2012 There is nothing wrong with change, if it is in the right direction Winston Churchill New tools provided by the Affordable Care Act are strengthening the Obama administration
More informationIndustry Funding of Continuing Medical Education
Industry Funding of Continuing Medical Education June 25, 2010 Julie K. Taitsman, M.D., J.D. Chief Medical Officer, Office of Inspector General U.S. Department of Health and Human Services Financial Relationships
More informationGlossary of Malpractice Insurance Terms
Glossary of Malpractice Insurance Terms To help you have a better understanding of Malpractice Insurance terms, this glossary has two sections. The first section contains definitions of general malpractice
More informationA Primer on Employment Agreements for New Physicians
A Primer on Employment Agreements for New Physicians Maine Chapter, American Academy of Pediatrics Resident Career Dinner Sea Dog Brewing Company, South Portland, Maine April 9, 2012 1 What is the law?
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 informationDo You Know What s In Your Physician Agreement?
Do You Know What s In Your Physician Agreement? by Andrea I. Schwab, JD, CPA 1 October 28, 2016 Notice: The information provided in this article is commentary of a general nature. It is not intended to
More informationApproved Models to Align Incentives between Hospitals and their Physicians
Approved Models to Align Incentives between Hospitals and their Physicians Agenda I. Alignment Model Overview II. Co-Management III. Clinically Integrated Networks CIN Definition & Overview Network Development
More informationImpact their income by leveraging a productivity formula by calculating the RVUs by different measures. They will:
A formula for success. Taking control of your compensation is a matter of breaking down the number of relative value units (RVUs) and patient visits (per year, per day, and per hour) and is key to achieving
More informationPI Compensation: Methods, Documentation, and Execution
PI Compensation: Methods, Documentation, and Execution David B. Russell, CRCP Director, Site Strategy Liz Christianson Client engagement manager PFS CLINICAL 2018 PharmaSeek Financial Services, LLC d.b.a.
More informationPI Compensation: Methods, Documentation, and Execution
PI Compensation: Methods, Documentation, and Execution David B. Russell, CRCP Director, Site Strategy Liz Christianson Client engagement manager PFS CLINICAL 2018 PharmaSeek Financial Services, LLC d.b.a.
More informationMedicare Parts C & D Fraud, Waste, and Abuse Training
Medicare Parts C & D Fraud, Waste, and Abuse Training IMPORTANT NOTE All persons who provide health or administrative services to Medicare enrollees must satisfy FWA training requirements. This module
More informationFAST BREAK : STARK LESSONS FOR PHYSICIAN PRACTICE ACQUISITIONS Albert Shay, Eric Knickrehm, and Jake Harper August 23, 2018
FAST BREAK : STARK LESSONS FOR PHYSICIAN PRACTICE ACQUISITIONS Albert Shay, Eric Knickrehm, and Jake Harper August 23, 2018 2018 Morgan, Lewis & Bockius LLP Agenda What is the Stark Law and what kind of
More informationDeveloped by the Centers for Medicare & Medicaid Services
Medicare Parts C and D Fraud, Waste, and Abuse Training Developed by the Centers for Medicare & Medicaid Services Why Do I Need Training? Every year millions of dollars are improperly spent because of
More informationMedicare Parts C & D Fraud, Waste, and Abuse Training and General Compliance Training. Developed by the Centers for Medicare & Medicaid Services
Medicare Parts C & D Fraud, Waste, and Abuse Training and General Compliance Training Developed by the Centers for Medicare & Medicaid Services Important Notice This training module consists of two parts:
More informationStark and the Anti Kickback Statute. Regulating Referral Relationship. February 27-28, HCCA Board Audit Committee Compliance Conference.
Stark and the Anti Kickback Statute Ryan Meade, JD, CHRC, CHC F Director, Regulatory Compliance Studies Beazley Institute for Health Law and Policy Loyola University Chicago School of Law rmeade@luc.edu
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 informationIME Provider Account Application
IME Provider Account Application Mail completed application to: Provider Quality and Compliance PO Box 44322 Olympia WA 98504-4322 A. Application Information I am applying as a(n): Individual Examiner
More informationInsights. Transaction Structure Insights. Charles A. Wilhoite. Winter 2009
Winter 2009 Transaction Structure Insights Insights 35 Health Care System Acquisitions of Medical Practices Charles A. Wilhoite Acquisitions of medical practices by health care systems, particularly tax-exempt
More informationOBJECTIVES 11/11/2013. Hospital Physician Relationships: Auditing Physician Arrangements and Physician Contracting HCCA Regional Conference
Hospital Physician Relationships: Auditing Physician Arrangements and Physician Contracting HCCA Regional Conference November 15, 2013 Scottsdale OBJECTIVES 1 2 3 4 Identify regulatory structures requiring
More informationACO: Shared Savings Model
ACO: Shared Savings Model Checklist of Key Questions Risk Upside only? Downside risk? How much? How will downside losses be paid for? Shared Savings How much of the savings will be shared (or retained
More informationIn this course, we will cover the following topics: The structure and purpose of Navicent Health s Compliance Program The requirements of the
In this course, we will cover the following topics: The structure and purpose of Navicent Health s Compliance Program The requirements of the Navicent Health s Corporate Integrity Agreement (CIA) Your
More informationINFORMATION ABOUT YOUR OXFORD COVERAGE
OXFORD HEALTH PLANS (CT), INC. INFORMATION ABOUT YOUR OXFORD COVERAGE PART I. REIMBURSEMENT Overview of Provider Reimbursement Methodologies Generally, Oxford pays Network Providers on a fee-for-service
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 informationService Terms & Conditions -- Recruiting
Service Terms & Conditions -- Recruiting Revised September 20, 2016 These Service Terms & Conditions Recruiting ( Recruiting Terms ) apply to Service Orders issued by DaVita Inc. ( DaVita ) or an entity
More informationManufacturer Patient Support Initiatives: Current Practices and Recent Challenges. Andrew Ruskin Morgan Lewis
Intersecting Worlds of Drug, Device, Biologics and Health Law AHLA/FDLI May 22, 2012 Manufacturer Patient Support Initiatives: Current Practices and Recent Challenges by Andrew Ruskin Morgan Lewis The
More informationWashington, DC Washington, DC 20510
September 13, 2017 The Honorable Lindsey Graham The Honorable Bill Cassidy United States Senate United States Senate Washington, DC 20510 Washington, DC 20510 Dear Senators Graham and Cassidy: On behalf
More informationFraud and Abuse Compliance for the Health IT Industry
Fraud and Abuse Compliance for the Health IT Industry Session 89, March 6, 2018 James A. Cannatti III, Senior Counselor for Health Information Technology, U.S. Department of Health and Human Services (HHS),
More informationAdvancing Risk Capability in 2015: Medicare Shared Savings Program and ACO Investment Model. March 23, 2015 // 12:00 P.M. 1:00 P.M.
Advancing Risk Capability in 2015: Medicare Shared Savings Program and ACO Investment Model March 23, 2015 // 12:00 P.M. 1:00 P.M. EST CENTER FOR INDUSTRY TRANSFORMATION The DHG Healthcare Center for Industry
More informationGifts to Referral Sources. Kim C. Stanger (11-17)
Gifts to Referral Sources Kim C. Stanger (11-17) Overview Some relevant laws Applying those laws to common situations Gifts to or from referral sources Gifts to physicians Gifts to or from patients Gifts
More informationMEMORANDUM OF AGREEMENT. University of Hawai i/
MEMORANDUM OF AGREEMENT University of Hawai i/ Name of Agency University Health Sciences Programs in Name of Agency Facilities This MEMORANDUM OF AGREEMENT (hereafter the Agreement ) is entered into this
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 informationStark Law Exceptions and Anti-Kickback Safe Harbors
Law Exceptions and Safe Harbors Fair Market Value Compensation exception to the referral prohibition related to [No comparable safe harbor] compensation arrangements for fair market value compensation
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 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 informationLegal Issues Pertaining to Athletic Trainers
Legal Issues Pertaining to Athletic Trainers Lakewood Orthopaedics & Sports Medicine Advanced Education Seminar January 24, 2015 Presented by: Ashley Johnston, J.D. (469)320-6061 ajohnston@grayreed.com
More informationOber Kaler Health Law Client Alert
2014 Ober Kaler Health Law Client Alert CMS Self-Disclosure Protocol Overview, Practical Tips and Summary of Settlements Prepared by: Catherine A. Martin 1 Principal, Ober Kaler camartin@ober.com 410.347.7320
More informationImproving Integrity in Nursing Centers
Improving Integrity in Nursing Centers Susan Edwards Reed Smith LLP AHCA/NCAL s General Counsel Goals of this webinar Introduce you to AHCA/NCAL s Fraud and Abuse Toolkit Provide you with a basic understanding
More informationDisability Coverage. Disability benefits help protect your income if you have an illness or injury that keeps you from working.
Disability Coverage Disability benefits help protect your income if you have an illness or injury that keeps you from working. Plan Highlights If you enroll in the voluntary STD benefit, you will be eligible
More informationGAINSHARING & PAY FOR PERFORMANCE -- P4P UPDATE ON RECENT DEVELOPMENTS AND INITIATIVES
GAINSHARING & PAY FOR PERFORMANCE -- P4P UPDATE ON RECENT DEVELOPMENTS AND INITIATIVES presented by Robert D. Girard, Esq. Davis Wright Tremaine LLP A. Gain-Sharing B. Provider P4P programs C. Government
More informationSuper Groups: Legal Issues Associated with the Formation of Large Multi-site Medical Groups
Super Groups: Legal Issues Associated with the Formation of Large Multi-site Medical Groups a presentation at Fornos of Spain Restaurant, 47 Ferry Street Newark, N.J. by: Michael F. Schaff, Esq. WILENTZ,
More informationPHYSICIAN EMPLOYMENT CONTRACTS AND NEGOTIATIONS CHRISTOPHER L. NULAND AACE GENERAL COUNSEL PRACTICE MANAGEMENT
PHYSICIAN EMPLOYMENT CONTRACTS AND NEGOTIATIONS CHRISTOPHER L. NULAND AACE GENERAL COUNSEL PRACTICE MANAGEMENT 101 2017 BASIC CONSIDERATIONS Basic Considerations A. Do I want to do this? B. Can I do this?
More informationAAMC UNIFORM TERMS AND CONDITIONS FOR PROGRAM LETTERS OF AGREEMENT
AAMC UNIFORM TERMS AND CONDITIONS FOR PROGRAM LETTERS OF AGREEMENT WHEREAS, the purpose of this document is to set forth the terms and conditions of the affiliation between Sponsoring Institution and Participating
More informationEmployment Agreement for Management Level Term. Construction
Employment Agreement for Management Level Term Construction Purpose of the Form. This is the full version of an Employment Agreement between a construction company and one of its management level employees.
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 informationHUDSON SPECIALTY INSURANCE COMPANY Employed Ancillary Provider Application for surplus lines coverage
HUDSON SPECIALTY INSURANCE COMPANY Employed Ancillary Provider Application for surplus lines coverage - If a question does not apply to you, write N/A. Do not leave any questions unanswered. - Include
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 informationHealth Law 101: Issue-Spotting In Dealing With Health-Care Providers. by William H. Hall Jr.
Health Law 101: Issue-Spotting In Dealing With Health-Care Providers by William H. Hall Jr. The anti-kickback statute prohibits arrangements that might be common in other industries. Health care is among
More informationDRAFT CSFO CONTRACT (Revised March 12, 2012)
EMPLOYMENT CONTRACT (CHIEF SCHOOL FINANCIAL OFFICER) DRAFT CSFO CONTRACT THIS CONTRACT is made by and between the BESTPLACE BOARD OF EDUCATION (hereinafter referred to as "BOARD" or "THE BOARD") and MACK
More informationProposed ACO Rule: A Giant Step Toward Reform or a Leap of Faith for Providers? April 27, 2011
Proposed ACO Rule: A Giant Step Toward Reform or a Leap of Faith for Providers? April 27, 2011 Barbara Eyman Ropes & Gray Barbara.Eyman@ropesgray.com 202.508.4760 Ropes & Gray LLP Stephen Warnke Ropes
More informationFundamentals of Healthcare Valuation
Carol Carden, CPA/ABV, ASA, CFE Page 0 Agenda Healthcare Industry Overview Healthcare Valuation Approaches Healthcare Valuation Considerations and Trends Recent Reform Initiatives Page 1 Healthcare Industry
More informationDental Participating Provider Service Agreement
P.O. Box 30192 Salt Lake City, UT 84130-0192 801-442-5038/800-538-5038 www.selecthealth.org Dental Participating Provider Service Agreement I. Introduction 1. This Dental Participating Provider Services
More informationOrganization. 4 Health Texas Senior Centers. VP, Internal Audit Team of 11 Auditors
Organization Regional Non-Profit Acute Care Hospital System 26 Owned/Operated/Ventured/Affiliated Hospitals 21 Joint Ventured Ambulatory Surgical Centers 41 Satellite Outpatient Facilities 136 Health Texas
More informationEMPLOYMENT AGREEMENT
THIS EMPLOYMENT AGREEMENT (this Agreement") is executed this «Contract_Day» day of «Contact_Month», «Contract_Year», by and between Utah HealthCare Institute, Inc. (Hereinafter referred to as the Employer"),
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 informationConsultant Application
Consultant Application Email: kimddonselaar@maximus.com 3750 Monroe Avenue, Suite 700 Pittsford, NY 14534 Tel: 585.348.3109 Fax: 585.869.3390 PERSONAL INFORMATION: Name: Home Address: Social Security No.:
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 information6/2015. Hospital Board Training Part 2: Laws Every Board Member Should Know. Holland & Hart LLP
Hospital Board Training Part 2: Laws Every Board Member Should Know (6-16) This presentation is similar to any other legal education materials designed to provide general information on pertinent legal
More informationFederal Administrative Sanctions
FEDERAL AND STATE ADMINISTRATIVE SANCTIONS HCCA COMPLIANCE INSTITUTE April 23, 2007 Chicago, IL Edgar D. Bueno Pillsbury Winthrop Shaw Pittman LLP John W. O Brien Office of Counsel to the Inspector General
More informationHealth Care Fraud for Physicians
Health Care Fraud for Physicians UNM Family Medicine Residency Program May 25, 2011 Or... Why I Should Have Never Become A Doctor In The First Place Fraud Fraud vs. Abuse Intentional deception or misrepresentation
More informationEMPLOYMENT AGREEMENT
EMPLOYMENT AGREEMENT THIS EMPLOYMENT AGREEMENT (hereinafter referred to as Agreement ), is by and between the City of Cocoa Beach, Florida, a subdivision of the State of Florida (hereinafter referred to
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 informationCity/State: From: To: City/State: From: To: City/State: From: To:
2. If you are currently insured on a claims-made policy, are you obtaining Extended Reporting Period (tail) from your current insurance carrier? Yes No N/A (have occurrence coverage now) Note: To prevent
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 information