Understanding the Anti-Kickback Statute is a must for healthcare providers and professionals

A proper understanding of the Anti-Kickback Statute (AKS) is completely necessary for healthcare providers and professionals.  It is among the strongest weapons in the government arsenal for enforcing the federal fraud and abuse laws. Along with Stark II (the federal physician anti-referral law), the Anti-Kickback Statute can be and is being used as the basis for an action brought under the Federal False Claims Act.

Recently enacted healthcare laws such as the Affordable Care Act, and the enhancement of enforcement and health care fraud taskforces of late, have combined to greatly strengthen the government’s enforcement resources. The government can now take recourse to what is called “responsible corporate officer doctrine”, which allows it to pin the blame on hospital CEOs and others as being directly responsible for the fraud.

What happens when the provisions of the Anti-Kickback Statute are not implemented properly and thoroughly? Healthcare providers end up coughing huge amounts of money as penalties. Two recent related cases -The Christ Hospital case in Cincinnati, where settlement cost more than $100 million, and the Hardeman Memorial Hospital case in Texas, with a settlement of close to half a million dollars -serve as an indication of how severe the penalties for nonenforcement of the provisions of AKS can be.

Penalties can be in other forms, too. Take the instance of the same Hardeman case. The CEO, Angela Edwards, was awarded an imprisonment term of over two years, and was ordered to pay restitution of more than a third of a million dollars.

Complete learning of the AKS from the expert

In view of all these, does it need iteration that complete and thorough knowledge of the AKS and the ways of implementing it is an absolute must for healthcare professionals and providers?

This is the learning a webinar from MentorHealth, a leading provider of professional trainings in all the areas of healthcare, will be providing. Dr. William Mack Copeland, who is president of Executive & Managerial Development Group, a consulting entity that provides compliance and other fraud and abuse related services and is a frequent author and speaker on health law topics; will be the speaker at this webinar. To gain complete knowledge of how the provisions of the Anti-Kickback statute apply to healthcare professionals and providers; please enroll for this session.

The Anti-Kickback statute and its safe harbors

This webinar will explain how violation of the Anti-Kickback Statute (AKS) can raise False Claims Act concerns, and will provide an assessment of enforcement activities, showing how participants may be at risk. The speaker will discuss the “safe harbors”, payment practices that will not be subject to criminal prosecution and that will not provide a basis for civil monetary penalties or exclusion from the Medicare or Medicaid programs. In this section, Dr. Copeland will explain the more frequently used safe harbors to show how protection from enforcement can be achieved. In particular, he will take up matters relating to the investment, space and equipment rental, personal services/management contracts, and physician recruitment safe harbors for review.

The OIG’s Joint Venture Advisory Opinion

Dr. Copeland will also discuss the OIG’s Joint Venture Advisory Opinion concerning a hospital that expands into a related service line by contracting with an existing provider of that service. The OIG has reservations with such an arrangement. In addition, the recent advisory opinion by the OIG regarding Physician-Owned Entities will be taken up for discussion. About this aspect, this is the OIG’s viewpoint; PODs are inherently suspect under the AKS because the OIG considers the opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, as illegal remuneration under the AKS.

The speaker will present examples of various cases in which the courts have judged compliance with it. He will review recent cases and show how they potentially impact participants. He will also review the case law, particularly the early case law that sets the stage and basis for how the courts interpret the law.

Healthcare executives, physicians and other health care providers who participate in and receive remuneration from Medicare, Medicaid, and other federal health care programs such as TriCare will find this session highly useful. Dr. Copeland will cover the following areas at this webinar:

• Federal Civil Anti-Kickback Statute
• Safe Harbors providing protection under the AKS
• Enforcement activities involving the AKS
• The OIG’s Joint Venture Advisory Opinion
• The OIG’s advisory opinion regarding Physician-Owned Entities and
• The anti-fraud provisions of the Affordable Care Act.

Fill the form to get more details about Anti-Kickback Statute

 

Vital Stark Law considerations for physician employment agreements

Since the Affordable Care Act (ACA) –popularly called Obamacare –came into existence, there has been an exponential increase in the number of physician practice acquisitions. Some of the reasons that can be ascribed for this phenomenon are these:

• Physician practice acquisitions are an opportunity for healthcare providers in consolidating and integrating their business better, as the business prospects of the referral networks align with the hospital’s strategic goals
• On account of the amendments brought about to the Medicare and Medicaid reimbursement systems, providers have been moving towards bundled and integrated payments of late. This system is well suited for hospitals with more physician practice acquisitions
• As the reimbursement rates of a few specialties fall, such specialists gain when their practice is attached to a bigger hospital brand. They feel secure when they have to negotiate contract rates. Being attached to a hospital also means that they have the financial security a consistent practice brings, something for which they have struggle for long periods if they were to be in their own private practice
• Both new and experienced physician practices gain when their practice gets acquired by hospitals. For experienced physicians; it is a means for augmenting their incomes. Younger physicians, on the other hand, get greater freedom to work at convenient and flexible times, leading to better work life balance, something that people of that age group, normally with a growing family, attach a premium to.

So, there is no question that physicians find favor with physician practice acquisitions. Given the rewards acquisitions bring to them; they are well advised to take utmost care to scrutinize the finer aspects of agreements while negotiating them. In addition to the pros and cons of what an acquisition means to their practice and to their profession; they also have to be highly diligent in looking at the legal aspects of the acquisition. Important legal and regulatory issues that govern physician practice acquisitions have to be taken note of before negotiating and signing physician practice acquisitions.

The Stark Law

The Physician Anti-Referral Law, or Stark II, or just the Stark Law, is the major federal law that deals with this aspect of healthcare practice. It is with the provisions of this law about physician referrals that any healthcare provider which files claims has to comply with.

Noncompliance invites enforcement actions

The primary objective of the Stark Law, which is implemented in stages known as Stark II and Stark III, is to eliminate the various malpractices that prevail in the healthcare sector. One of the important means by which the Stark Laws does this is by considering certain physician actions as unlawful. So, all these aspects, along with the changes that the Stark Law brought in in 2016, need to be carefully taken note of when negotiating physician practice acquisition agreements.

This thoroughness is crucial also because Stark Law enforcement actions hand significant awards and settlements. It is imperative for medical groups, hospitals, and health systems that move towards integration and work out innovative hospital-physician arrangements to be completely compliant with the provisions of the law, so that they put in place compensation arrangements that are defensible under the Stark Law.

Gain familiarity with the Stark Law

Need to understand all the intricate aspects of how to draft physician practice acquisitions that are compliant with the provisions of the Stark Law, both from the hospitals’ and the physicians’ side? Then, just enroll for a highly interesting webinar on this topic that is being organized by MentorHealth, a leading provider of professional trainings for the healthcare industry.

Joseph Wolfe, who is an attorney with Hall, Render, Killian, Heath & Lyman, P.C., the largest health care focused law firm in the country, and offers advice and counsel to some of the nation’s largest health systems, hospitals and medical groups on a variety of health care issues; will be the speaker at this webinar.

Please register for this webinar to gain the important insights needed for getting a grasp of the legal aspects of the Stark Law on physician practice acquisitions. This Course is approved for 1 general credit from the Nevada Board of Continuing Legal Education.

Simplification of the legally compliant physician practice acquisition agreements

Joseph will describe the ways by which to understand and interpret the contents of the Stark Law for drafting meaningful and legally compliant physician practice acquisition agreements. He will explain the important factors that need to be carefully analyzed and scrutinized when working out physician practice acquisitions.

Everyone connected with Stark Law and its implementation, namely professionals such as In-House Counsel, Healthcare Compliance Officers, Healthcare Human Resources, Healthcare CFO’s, and other levels of healthcare executives, will find this session very useful. Joseph will cover the following areas:

• Provide a general Stark Law overview
• Examine critical components of Stark and Anti-Kickback compliant employment arrangements
• Discuss best practices for drafting physician employment agreements, related compensation plans and facilitating effective onboarding
• Discuss best practices for auditing existing employment arrangements
• Describe alternative structures for organizations intending to qualify as Stark group practices.

Ensuring compensation-focused compliance with Stark Law considerations

Stark Law compliance is now more than just a compliance issue. It has grown to become an Enterprise Risk Management matter, if the substantial awards and settlements in recent enforcement actions are anything to go by. For healthcare organizations that develop and implement provider contracts; managing their compliance and enterprise risk by ensuring that their physician employment arrangements are defensible under the Stark Law, both in substance and in technical detail. is now not a choice. It is an imperative.

How do healthcare organizations achieve all this? This is the teaching a webinar from MentorHealth, a leading provider of professional trainings for the healthcare industry, will impart.

A thorough learning session

Joseph Wolfe, an attorney with Hall, Render, Killian, Heath & Lyman, P.C., the largest health care focused law firm in the country, will be the speaker at this webinar. To gain the benefit of his knowledge of the Stark Law, please register for this webinar .This webinar is approved for 1 general credit from the Nevada Board of Continuing Legal Education.

Compensation-focused Compliance

At this webinar, Joseph, who provides advice and counsel to some of the nation’s largest health systems, hospitals and medical groups on a variety of health care issues and regularly counsels clients on a national basis regarding compliance-focused physician compensation and alignment strategies, will discuss strategies for ensuring physician compensation plans and compensation-focused governance processes support compliance.

Key healthcare personnel such as Physicians and Practice Managers, Governing Board Members, Trustees and Directors, Healthcare Executives, In-House Counsel, Healthcare Human Resources, Healthcare CFO’s, and healthcare Compliance Officers will derive deep and valuable learning from this session.

Joseph will cover the following areas at this webinar session:

• Provide a general overview of the Stark Law
• Explain the requirements for compliance with key regulatory exceptions
• Discuss best practices for documenting compliance with three key tenets of defensibility (e.g.. fair market value, commercial reasonableness, and not taking into account designated health service referrals, etc.).

Physician Leases need to be structured under the new 2016 Stark Rules

Stark Law, more formally referred to as The Physician Anti-Referral Law (known as Stark II), is a prominent law concerning physician referrals. Healthcare providers that file claims require compliance with the Stark rules. Failure to comply can invite an enforcement action. The fundamental aim of this law is the elimination of malpractices in the healthcare sector. Implemented in stages known as Stark II and Stark III; the Stark Laws consider particular actions on the part of the physician as unlawful.

Of late, Stark Law enforcement actions have led to substantial awards and settlements. Due to this, Stark Law compliance has moved from being just a compliance issue. It is now an Enterprise Risk Management (ERM) issue. With more and more medical groups, hospitals, and health systems pursuing integration strategies and transitioning to more innovative hospital-physician arrangements; putting in place compensation arrangements that are defensible under the Stark Law is the way forward for them for managing their compliance and enterprise risk.

Get to understand all aspects of the Stark Law for 2016

More on the Stark Law can be understood from a webinar that MentorHealth, a leading provider of professional trainings for the areas of healthcare, will be organizing. Participants can enroll for this highly important and interesting webinar by logging on to http://bit.ly/Physician-Leases-need-to-be-structured-2016-StarkRules

Wolfe, an attorney with Hall, Render, Killian, Heath & Lyman, P.C., the largest health care focused law firm in the country; will offer a general Stark Law overview at this webinar. He will also explain best practices for auditing existing space lease arrangements and for implementing new time-share arrangements under the new 2016 Stark rules. This learning will be highly useful for In-House Counsel, Health Care Compliance Officers, Health Care Human Resources, Health Care CFO’s, and Health Care executives.

Wolfe will cover the following areas at this session:

• Provide a general overview of the Stark Law in its current form
• A general Stark Law overview
• Explain the regulatory requirements for compliance with key regulatory exceptions and safe harbors for leases
• Summarize the upcoming changes to the Stark Law for 2016
• Discuss best practices for auditing existing space lease arrangements and for implementing new time share arrangements