Anti-Kickback Statute Jess Smith
|
|
- Hollie Goodwin
- 5 years ago
- Views:
Transcription
1 Anti-Kickback Statute Jess Smith
2 Overview Enacted Violation became a felony Expanded to include all Federal Health Care Programs Health Care Fraud Prevention and Enforcement Action Team (HEAT)
3 Federal Anti-Kickback Statute 42 U.S.C. 1320a-7b. Is a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of federal health care program business.
4 One Purpose Test Established United States v. Greber (U.S. v. Greber (3d Cir. 1985)) Definition if one purpose of the payment was to induce future referrals, the Medicare statute has been violated.
5 Application Applies to anyone who solicits, receives, offers or pays with intent to induce or reward referrals for federal program business. Providers Vendors Managers or administrators Marketing personnel Anyone else Applies to participants on both sides of the transaction!
6 Applies to referrals for items or services covered by a federal health care program Medicare Medicaid Other federal programs Limiting to non-medicare/medicaid or other Federal programs does not necessarily insulate the arrangement States have AKS and many apply to any source of patients.
7 Applies to any form of remuneration in exchange for referrals for federal program business Money Contracts for services Free or discounted items or services Over/under payments (i.e. not fair market value) Waivers of copays or deductibles Anything of value
8 AKS Violations are a Felony
9 AKS Penalties 5 years in prison per offense $25,000 fine per offense (42 USC 1320a-7b(b))
10 AKS Violation = Civil Monetary Violation
11 Civil Monetary Penalties $50,000 civil monetary penalties per violation AND 3 times the payments received AND Exclusion from ALL Federal Healthcare Programs Medicare/Medicaid/Tricare/etc (42 USC 1320a-7a(a)(7))
12 Federal Health Care Programs Exclusion (i.e.: Medicare, Medicaid, TRICARE, VA) Impact items or services that are furnished, ordered, or prescribed will not be covered Entity may not bill directly for treating Medicare and Medicaid patients Services cannot be billed indirectly through an employer or a group practice No order or prescription that is provided to a private-pay patient will be reimbursable by any Federal health care program.
13 AKS Violation = False Claims Act Violation
14 False Claims Act violation (Civil Violation) Preponderance of Evidence Standard $ $11000 per violation 3 x damages Qui tam lawsuit
15 STARK LAW: Lou Paravate
16 1) "Stark" is a set of United States federal laws named after US Congressman Pete Stark. (Example: "Fulbright Scholarships" or "Monroney Stickers.") Stark prohibits referrals by a physician of Medicare or Medicaid patients to an entity that provides any of 12 designated health services in which the physician or immediate family member has a financial relationship. Stark is otherwise known as "The Federal Physician Self-Referral Prohibition" or "The Ethics In Patient Referrals' Act." Because of it's maze-like complexity, I prefer to (sarcastically) call Stark the "Healthcare Attorney Full Employment Act."
17 2) The bill was introduced in Congress in 1988 and became law in 1990, effective January 1, Subsequent amendments and additions were passed in 1993 (Stark II), 2001, 2004, 2007 (Stark III) and ) The concept behind Stark is that "a doctor should never receive financial gain for recommending a treatment that the doctor does not personally provide." And that a "self-referral" is an inherent conflict of interest which encourages overutilization of services, which in turn drives up health care costs.
18 Those who oppose Stark argue that physicians who own, invest in or operate medical facilities are responding to a need which might otherwise not be met, particularly in medically underserved areas. In addition, physician owned entities often offer a lower cost alternative to facilities that are located in hospitals, because hospitals usually have higher overhead costs. It is my personal opinion that Stark discourages creativity and innovation in health care. Doctors are on the front lines of patient care and are the first to spot a medical need and better respond to that need.
19 4) Acting alone, a physician (or those within his office or group) cannot violate Stark Law through the in-house treatment of a patient, because there is no "outside referral" to someone else. 5) Numerous other laws and regulations may overlap or apply: fee-splitting prohibitions, notice requirements, Medicare conditions of participation and billing rules like Anti-Markup. Your own state's fraud and abuse statutes may or may not mirror the federal rules.
20 6) Stark initially only applied to clinical laboratory services. Now Stark applies to a large number of services or "Designated Health Services" (DHS). Please remember that term, "DHS." A would DHS include but not be limited to one of these 12 categories: Clinical labs, physical therapy, occupational therapy, outpatient speech pathology, radiology and some imaging, radiation therapy, durable medical equipment, nutrients, prosthetics, home health series, outpatient prescription drugs and inpatient and outpatient hospital services.
21 7) Stark penalties could be: A) Denial of payment, B) Three times refund of payment, C) $15,000 penalty per service, D) $100,000 per circumvention scheme and E) Exclusion from Medicare/Medicaid programs. Multiple federal entities oversee Stark enforcement including Department of Justice, Centers for Medicare and Medicaid Services (CMS) and Department of Health and Human Services Office of Inspector General (OIG). 8) Stark applies to doctors, dentists, optometrists and chiropractors.
22 9) "Immediate family members" goes as far out as grandparents, grandchildren and in-laws, whether they be natural or adoptive. 10) "Financial relationship" includes ownership, investment interest or compensation arrangements. 11) Stark contains several exceptions including physician services, in-office ancillary services, ownership in publicly traded stock, rental of office space and equipment and bona fide employment relationships. A recent Stark exception is for imaging services to be provided within a group practice. Even then, the practice must provide the patient with a list of alternate sources for the service offered where the patient resides.
23 12) There are seven "Safe Harbors" in contracts between physicians and hospitals: A) The contract must be for a least a year B) In writing signed by both parties C) Specific aggregate payment which is set in advance D) Payment is reasonable fair market value E) Payment not related to volume or value of business F) Exact services to be performed must be outlined G) Must be commercially reasonable
24 13) The concept of Stark, but not necessarily Stark itself, has four levels: A) The federal level which covers federal programs like Medicare/Medicaid. B) The state level which may add regulations on top of the federal regulations (but almost always cannot diminish them) and may extend Stark type regulations to commercial insurance. Please see your individual state laws regarding self-referral prohibitions. C) Individual in-state commercial insurance contracts may contain self-referral prohibitions. D) National commercial insurance contracts (i.e. Humana) may contain self-referral prohibitions.
25 14) Just as we have 10,000 laws to enforce the Ten Commandments, use your common sense regarding Stark. If it seems unethical, it probably is.
26 Quiz
Gifts 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 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 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 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 informationStark, AKS, FCA Primer
Stark, AKS, FCA Primer December 1, 2016 Christine Savage (csavage@choate.com, 617-248-4084) by any measure CHOATE HALL & STEWART LLP choate.com Physician Self-Referral Prohibition (the Stark Law ): History
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 informationFraud and Abuse Laws. Kim C. Stanger. Compliance Bootcamp (5/18)
Fraud and Abuse Laws Kim C. Stanger Compliance Bootcamp (5/18) This presentation is similar to any other legal education materials designed to provide general information on pertinent legal topics. The
More informationMedical Ethics. Paul W. Kim, JD, MPH O B E R K A L E R
Medical Ethics Paul W. Kim, JD, MPH O B E R K A L E R 410-347-7344 pwkim@ober.com 1 Agenda Federal Fraud & Abuse Laws Federal Privacy Laws Enrollment Audits Post-Payment Audits Pre-Payment Reviews 2 False
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 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 informationLaw Department Policy No. L-8. Title:
I. SCOPE: Title: Page: 1 of 13 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2) any other entity or organization in which
More informationStark/Anti- Kickback Fundamentals
Stark/Anti- Kickback Fundamentals HEALTHCON Business Expo April 2016 Presented by: Stacy Harper, JD, MHSA, CPC 1 Disclaimer This presentation is for general education purposes only. The information contained
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 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 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 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 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 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 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 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 informationThis course is designed to provide Part B providers with an overview of the Medicare Fraud and Abuse program including:
This course is designed to provide Part B providers with an overview of the Medicare Fraud and Abuse program including: Medicare Trust Fund Defining Fraud & Abuse Examples of Fraud & Abuse Fraud & Abuse
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 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 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 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 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 informationOFFICE OF INSPECTOR GENERAL WORK PLAN FISCAL YEAR 2006 MEDICARE HOSPITALS
OFFICE OF INSPECTOR GENERAL WORK PLAN FISCAL YEAR 2006 MEDICARE HOSPITALS GABRIEL L. IMPERATO, Esq. Broad & Cassel Fort Lauderdale, Fl. Medicare Hospitals Areas of Focus for OIG Work Plan 2006 Adjustments
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 informationTHE CHRIST HOSPITAL POLICY NO.: ADMINISTRATIVE POLICY PAGE 1 OF 9
ADMINISTRATIVE POLICY PAGE 1 OF 9 POLICY TITLE: ORIGINATED BY: APPROVED BY: AGREEMENTS WITH PHYSICIANS AND OTHER POTENTIAL REFERRAL SOURCES: GENERAL POLICY COMPLIANCE OFFICER COMPLIANCE COMMITTEE REVIEWED/REVISED:
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 informationAnti-Kickback Statute and False Claims Act Enforcement
Anti-Kickback Statute and False Claims Act Enforcement Nicholas Gachassin, III, Esq. Gachassin Law Firm, LLC Nick3@gachassin.com Press Conference on Health Care Fraud and the Affordable Care Act May 13,
More informationFraud and Abuse Laws: Understanding, Applying and Avoiding Liability
Fraud and Abuse Laws: Understanding, Applying and Avoiding Liability Kim C. Stanger (1/17) This presentation is similar to any other legal education materials designed to provide general information on
More informationPhysician s Guide to Stark Law Part I
Physician s Guide to Stark Law Part I Authored by W. Scott Keaty and Joshua G. McDiarmid Kantrow, Spaht, Weaver & Blitzer (APLC) Date: August 15, 2016 Physicians are under increasing scrutiny by federal
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 informationMANAGING HOSPITAL/PHYSICIAN FINANCIAL RELATIONSHIPS
MANAGING HOSPITAL/PHYSICIAN FINANCIAL RELATIONSHIPS James D. Horwitz, Esq. HCCA Annual Compliance Institute April 27, 2009 AGENDA Laws and Environment Application of laws, agency actions and guidance to
More informationANCILLARY services: How to Stay Out of Trouble. The neurosurgical minefield Informed consent
ANCILLARY services: How to Stay Out of Trouble Richard N.W. Wohns, M.D. JD, MBA NeoSpine, Puget Sound Region, Washington The neurosurgical minefield 2013 Informed consent HIPAA ARRA and HITECH Anti-Kickback
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 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 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 informationEnsuring Compliance with the Law - Properly Structuring Innovative Marketing and Creative Joint Ventures. Top 5 Things to Know for CE:
Ensuring Compliance with the Law - Properly Structuring Innovative Marketing and Creative Joint Ventures Clay Stribling, Esq. Top 5 Things to Know for CE: 1. Make sure your BADGE IS SCANNED each time you
More informationEnsuring Compliance with the Law - Properly Structuring Innovative Marketing and Creative Joint Ventures. Clay Stribling, Esq.
Ensuring Compliance with the Law - Properly Structuring Innovative Marketing and Creative Joint Ventures Clay Stribling, Esq. Top 5 Things to Know for CE: 1. Make sure your BADGE IS SCANNED each time you
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 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 informationLIFEBLOOD OF THE SUCCESSFUL PHARMACY: MARKETING, JOINT VENTURES, AND ARRANGEMENTS WITH REFERRAL SOURCES WHILE REMAINING WITHIN LEGAL PARAMETERS
LIFEBLOOD OF THE SUCCESSFUL PHARMACY: MARKETING, JOINT VENTURES, AND ARRANGEMENTS WITH REFERRAL SOURCES WHILE REMAINING WITHIN LEGAL PARAMETERS Denise M. Leard, Esq. 2018 Brown & Fortunato, P.C. INTRODUCTION
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 informationAnti-Fraud Plan. Care1st Health Plan Arizona, Inc./ ONECare by Care1st Health Plan Arizona, Inc.
Care1st Health Plan Arizona, Inc./ ONECare by Care1st Health Plan Arizona, Inc. Anti-Fraud Plan This document contains (a) Care1st Health Plan and ONECare by Care1st Health Plan Arizona, Inc. (HMO SNP)
More informationValuation of Health Care Entity Property or Services Transfers
Health Care Valuation Insights Valuation of Health Care Entity Property or Services Transfers Robert F. Reilly, CPA Health care providers comply with a myriad of professional regulations. Health care providers
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 informationPrivate Equity Investments in Health Care Practices
Private Equity Investments in Health Care Practices August 28, 2017 Yale H. Bohn bohny@pepperlaw.com PRIVATE EQUITY FUNDS ARE GENERALLY PROHIBITED FROM OWNING ENTITIES THAT EMPLOY LICENSED PROFESSIONALS
More informationS ark L aw aw An A t n i-kickbac b k S atut u e an an d Fal F se Cl C aims A c A t E f n orcement Jay y P. P A n A sti t n i e, e JD R adma m p
Stark Law, Anti-kickback Statute and False Claims Act Enforcement Jay P. Anstine, JD HCCA Physician Practice Compliance Conference Philadelphia, PA October 17-19, 19, 2010 1 Roadmap Fraud and Abuse laws
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 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 informationPROPOSED STARK LAW REVISIONS COULD AFFECT MANY EXISTING BUSINESS ARRANGEMENTS BETWEEN PHYSICIANS AND HOSPITALS AND OTHER PROVIDERS
PROPOSED STARK LAW REVISIONS COULD AFFECT MANY EXISTING BUSINESS ARRANGEMENTS BETWEEN PHYSICIANS AND HOSPITALS AND OTHER PROVIDERS Publication PROPOSED STARK LAW REVISIONS COULD AFFECT MANY EXISTING BUSINESS
More informationFAST BREAK : HOLIDAY GIFTS Jake Harper December 18, Morgan, Lewis & Bockius LLP
FAST BREAK : HOLIDAY GIFTS Jake Harper December 18, 2018 2018 Morgan, Lewis & Bockius LLP Agenda Holiday Gifts and the Laws They May Trigger Stark Beneficiary Inducement CMP AKS One-purpose Test Considerations
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 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 informationPhysician Contracting An Overview of Legal Policy No. 9
Physician Contracting An Overview of Legal Policy No. 9 Learning Objectives To Understand: CHI policy requirements for physician contracting Recent updates to Legal Policy No. 9 How to obtain review and
More informationMission Statement. Compliance & Fraud, Waste and Abuse Training for Network Providers 1/31/2019
Compliance & Fraud, Waste and Abuse Training for Network Providers Mission Statement To promote the quality of life of our communities by empowering others and working together to creatively solve unique
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 informationPHYSICIAN PRACTICES IN A STARK WORLD. David E. Matyas. A. The Statutory Prohibition (Social Security Act 1877; 42 U.S.C. 1395nn)
PHYSICIAN PRACTICES IN A STARK WORLD David E. Matyas I. OVERVIEW OF THE STARK LAW A. The Statutory Prohibition (Social Security Act 1877; 42 U.S.C. 1395nn) The federal physician self-referral statute prohibits
More informationAnti-Kickback Statute: Are Per-Patient Referral Fee Arrangements Permissible?
REFERRAL COMPENSATION GREGORY S. SAIK.IN/NATHANIEL C. KUMMERFELD* Anti-Kickback Statute: Are Per-Patient Referral Fee Arrangements Permissible? Federal Judge's Decision in United States v. Crinel Allows
More informationDEFICIT REDUCTION ACT AND FALSE CLAIMS POLICY INFORMATION FOR All NEW YORK WORKFORCE MEMBERS
DEFICIT REDUCTION ACT AND FALSE CLAIMS POLICY INFORMATION FOR All NEW YORK WORKFORCE MEMBERS The Company is committed to preventing health care fraud, waste and abuse and complying with applicable state
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 informationStark Law Contracting Tips and Problem-Solving May 14, 2015
Stark Law Contracting Tips and Problem-Solving May 14, 2015 Presented by: Bill Hoffman Polsinelli PC. In California, Polsinelli LLP Presentation Agenda Overview of the Stark Law and Differences from the
More informationTelemedicine Fraud and Abuse Under the Microscope
Telemedicine Fraud and Abuse Under the Microscope Session 232, February 14, 2019 Douglas Grimm, Esq., Arent Fox LLP Hillary Stemple, Esq., Arent Fox LLP 1 Conflicts of Interest Douglas Grimm, Esq. Has
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES. Office of Inspector General s Use of Agreements to Protect the Integrity of Federal Health Care Programs
United States Government Accountability Office Report to Congressional Requesters April 2018 DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Inspector General s Use of Agreements to Protect the Integrity
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 informationFRAUD, WASTE, & ABUSE (FWA) for Brokers. revised 10/17
FRAUD, WASTE, & ABUSE (FWA) for Brokers revised 10/17 OBJECTIVES After reviewing this information, you will be able to: Understand Fraud, Waste, and Abuse (FWA) training requirements; Be familiar with
More informationSCHEMES, SCAMS AND FLIM-FLAMS: HOW THE DME SUPPLIER CAN RECOGNIZE FRAUD LANDMINES. Denise Leard, Esq Brown & Fortunato, P.C.
SCHEMES, SCAMS AND FLIM-FLAMS: HOW THE DME SUPPLIER CAN RECOGNIZE FRAUD LANDMINES Denise Leard, Esq. 2017 Brown & Fortunato, P.C. INTRODUCTION 2 INTRODUCTION When Medicare first came into existence, there
More informationCurrent Status: Active PolicyStat ID: Fraud, Waste and Abuse
Current Status: Active PolicyStat ID: 2397820 Policy Scope: Date Of Origin: 06/2015 Last Approved: 07/2016 Last Revised: 07/2016 Next Review: 07/2018 Sponsor: Policy Area: Regulatory Tags: Applicability:
More informationPractical Considerations for Medical Practices Considering Converting Their Vascular Access Centers Into Medicare-Certified Ambulatory Surgery Centers
Practical Considerations for Medical Practices Considering Converting Their Vascular Access Centers Into Medicare-Certified Ambulatory Surgery Centers James B. Riley, Partner +1 312 750 8665 jriley@mcguirewoods.com
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 informationThe Anti-Kickback Statute. May 3, 2013 Tennessee Hospice Organization Compliance Forum
The Anti-Kickback Statute May 3, 2013 Tennessee Hospice Organization Compliance Forum 1 Overview The anti-kickback statute prohibits in the health care industry some practices that are common in other
More informationAudit, Compliance, and Regulatory Guidelines
Audit, Compliance, and Regulatory Guidelines Presented by: Rae Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CCS Some set disclaimer thingy----- Federal Regulations Fraud and Abuse Regulations Some set disclaimer
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 informationRepay Overpayments (18 USC 1347; 42 CFR et seq.)
Repay Overpayments (18 USC 1347; 42 CFR 401.301 et seq.) Repaying Overpayments If provider has received an overpayment, provider must: Return the overpayment to federal agency, state, intermediary, or
More informationAHLA. F. Anti-Kickback Primer. David E. Matyas Epstein Becker & Green PC Washington, DC
AHLA F. Anti-Kickback Primer David E. Matyas Epstein Becker & Green PC Washington, DC Martha J. Talley Chief, Industry Guidance Branch Office of the Inspector General US Department of Health and Human
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 informationSupplemental Special Advisory Bulletin: Independent Charity. Patients who cannot afford their cost-sharing obligations
Supplemental Special Advisory Bulletin: Independent Charity Patient Assistance Programs I. Introduction Patients who cannot afford their cost-sharing obligations for prescription drugs may be able to obtain
More informationHEALTH CARE FRAUD. EXPERT ANALYSIS HHS OIG Adopts New Anti-Kickback Safe Harbor and Civil Monetary Penalty Exceptions
Westlaw Journal HEALTH CARE FRAUD Litigation News and Analysis Legislation Regulation Expert Commentary VOLUME 22, ISSUE 7 / JANUARY 2017 EXPERT ANALYSIS HHS OIG Adopts New Anti-Kickback Safe Harbor and
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 informationHCCA Compliance Institute Dallas, Texas Session 401- Monday, April 19, 2010
Take a Second Look at Your Physician Relationships: Tips Based on Experience and Changes in the Law HCCA Compliance Institute Dallas, Texas Session 401- Monday, April 19, 2010 Jana Kolarik Anderson, Attorney
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 informationCORPORATE COMPLIANCE POLICY AND PROCEDURE
Title: Fraud Waste and Abuse Laws in Health Care Policy # 1011 Sponsor: Corporate Compliance Approved by: Russell J. Matuszak, Interim Director, Corporate Compliance and Chief Privacy Officer Issued: Page:
More informationLegal Issues: Fraud and Abuse Navigating Stark and Kickback. Reece Hirsch, Esq. Jordana Schwartz, Esq. HIT Summit West March 7, 2005
Legal Issues: Fraud and Abuse Navigating Stark and Kickback Reece Hirsch, Esq. Jordana Schwartz, Esq. HIT Summit West March 7, 2005 The Counterintuitive Industry Business arrangements that make perfect
More informationStark Law Making the Confusion Understandable
Stark Law Making the Confusion Understandable Robert A. Wade Partner Krieg DeVault LLP 4101 Edison Lakes Parkway, Suite 100 Mishawaka, IN 46545 Telephone: 574-485-2002 Email: bwade@kdlegal.com Learning
More informationCompliance Program. Health First Health Plans Medicare Parts C & D Training
Compliance Program Health First Health Plans Medicare Parts C & D Training Compliance Training Objectives Meeting regulatory requirements Defining an effective compliance program Communicating the obligation
More informationThe Impact of the Fraud and Abuse Laws on Pharmaceutical Advertising and Marketing Compliance: A Manufacturer s Perspective
International In-house Counsel Journal Vol. 4, No. 13, Autumn 2010, 1 The Impact of the Fraud and Abuse Laws on Pharmaceutical Advertising and Marketing Compliance: A Manufacturer s Perspective LESLIE
More informationThe Anesthesia Company Model: Frequently Asked Questions
The Anesthesia Company Model: Frequently Asked Questions 1. What is the situation in Florida? Florida-specific Issues For several years, FSA members have been contacting the society with reports of company
More informationSTARK ENFORCEMENT. BY ROBERT G. HOMCHICK Partner, Davis Wright Tremaine LLP (206) I.
STARK ENFORCEMENT BY ROBERT G. HOMCHICK Partner, Davis Wright Tremaine LLP (206) 628-7676 roberthomchick@dwt.com The Federal Physician s Self-referral or Stark law is a broad-based prohibition limiting
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 informationWikiLeaks Document Release
WikiLeaks Document Release February 2, 2009 Congressional Research Service Report RL32494 Medicare: Physician Self-Referral ( Stark I and II ) Jennifer OSullivan, Domestic Social Policy Division September
More informationMARSHALL L. MATZ MARK L. ITZKOFF *PRACTICE WITHIN THE DISTRICT OF COLUMBIA IS LIMITED TO MATTERS AND PROCEEDINGS BEFORE FEDERAL COURTS AND AGENCIES
PHILIP C. OLSSON ATTORNEYS AT LAW TISH E. PAHL RICHARD L. FRANK SUITE 400 ROBERT A. HAHN DAVID F. WEEDA (1948-2001) 1400 SIXTEENTH STREET, N.W. NAOMI J. L. HALPERN DENNIS R. JOHNSON WASHINGTON, D.C. 20036-2220
More informationWhat is the HHS OIG?
An Update on Government Enforcement Actions from the OIG HCCA - Southwest Regional Annual Conference February 21, 2014 Karen Glassman, Senior Counsel Office of Counsel to the Inspector General What is
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 informationDisclaimer LEGAL ISSUES IN PHYSICAL THERAPY
LEGAL ISSUES IN PHYSICAL THERAPY Paul J. Welk, PT, JD Tucker Arensberg, P.C. pwelk@tuckerlaw.com 2017 PHCA Annual Convention 1 Disclaimer The purpose of this presentation is to provide a general overview
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 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 information