Catch Me If You Can: Mitigating Compliance Risk Related To Provider Compensation
With ongoing regulatory changes and an evolving healthcare environment, it is likely that the Department of Justice (DOJ) will maintain its focus on enforcing actions against healthcare providers who prioritize their financial gains over patient well-being and unlawfully siphon funds from government programs. In this presentation, we will discuss recent enforcement actions and highlight themes related to specialty and methodology. We will also describe how organizations should manage Stark law and antikickback violations when prevention ...
Healthcare whistleblower case regarding FMV can proceed
The CFO of a healthcare provider blew the whistle on his former employer, alleging it overpaid for a surgery center in order to induce it to refer future business.
Kuzma v. N. Ariz. Healthcare Corp.
The defendants in this qui tam case asked for summary judgment against the plaintiff Relator, who had alleged violations of the False Claims Act as it related to the sale of Surgery and Rehabilitation Centers by the defendants. Relator brought suit against the defendants, alleging they violated the FCA by overpaying the physician-owners of the Summit Center to reward them for past business and to induce future business in violation of the federal Anti-Kickback Statute. The defendants advanced three arguments in favor of summary judgment: (1) the acquisition price paid for the Summit Center was fair market value; (2) Relator had no evidence that the defendants acted with the requisite scienter; and (3) Relator cannot show a causal link between the alleged kickback and the submission of false claims.
U.S. District Court Partially Denies Motion for Summary Judgment Regarding Qui Tam Case on Excess Purchase Price Under the False Claims Act
The defendants in this qui tam case asked for summary judgment against the plaintiff Relator, who had alleged violations of the False Claims Act as it related to the sale of Surgery and Rehabilitation Centers by the defendants. Relator brought suit against the defendants, alleging they violated the FCA by overpaying the physician-owners of the Summit Center to reward them for past business and to induce future business in violation of the federal Anti-Kickback Statute. The defendants advanced three arguments in favor of summary judgment: (1) the acquisition price paid for the Summit Center was fair market value; (2) Relator had no evidence that the defendants acted with the requisite scienter; and (3) Relator cannot show a causal link between the alleged kickback and the submission of false claims.
Stark Differences from the Inside Out: Two Key Responders Discuss The Final Stark Regulations for FMV and Commercial Reasonableness
The Stark regulations have been updated. What has changed and how does it impact value? Mark Dietrich and Tim Smith were two major contributors of public comments to the Centers for Medicare & Medicaid (CMS) for the updated Stark regulations with over 100 pages of newly written material that was influential in the development of the final regulatory definitions for FMV and commercial reasonableness. In addition, they included over a dozen chapters from the BVR/AHLA ...
Healthcare Valuation Townhall: Four Expert Panel on Covid-19 Impacts and Beyond
Bring your questions as leading experts Jerry Chang, Mark Deitrich, James Lloyd and Todd Sorensen have a conversation about the critical issues impacting healthcare. Covid-19 has impacted the healthcare industry in unique ways, and those valuation experts who practice in this high regulation environment know it is critical to keep up to date about the most pressing issues. Covering a wide range of issues from four perspectives this event delivers the insight you need in ...
Healthcare Valuation in the Corona Virus Era: That Was Then, This Is Now
COVID-19 has impacted perhaps no industry in such a complex way as healthcare. Join Mark Dietrich in this discussion of items to consider before you forecast the likely impact on the healthcare industry of the current crisis. First, it is necessary to understand where the industry was before COVID-19 and then to understand what the crisis revealed about the allocation of resources. Second, you need to consider where future spending will be directed and how ...
Healthcare Valuation Legal Check Up: Top Issues, Cases, and Hot Topics
Regulatory scrutiny of health care arrangements and fair market value is at an all-time high. In this webinar Joe Wolfe will discuss top issues, cases and hot topics in health care valuation from an attorney’s perspective. The webinar will cover key regulatory requirements (Stark, Anti-Kickback, tax exemption), enforcement trends, developing best practices for structuring appraisal engagements and potential pitfalls in reviewing and drafting written FMV opinions. Joe Wolfe will also discuss recent government guidance on ...
Beyond FMV: Commercial Reasonableness of Physician Compensation Post-MACRA
The influx of federal money over the past several decades to healthcare providers, and the allocation of those dollars, drastically transformed the healthcare delivery system in a way that has had dramatic impact on the economic and financial value of healthcare enterprises, assets, and services. The recent paradigm shift in the reimbursement environment, from volume to value, has had perhaps the greatest impact on the processes and outcomes of valuation assignments, as the reimbursement environment ...
Commercial Reasonableness: Defining Practical Concepts and Determining Compliance in Healthcare Transactions for Physician Services
Financial relationships between hospitals and physicians must be both commercially reasonable and at fair market value (FMV) to meet certain regulatory requirements. Ensuring compliance with these requirements is critical--failing to do so could invoke sanctions and penalties related to the Stark Law, the Anti-Kickback Statute, the False Claims Act (FCA), and Internal Revenue Service 501(c)(3) status for tax-exempt entities. As such, a thorough understanding of these requirements is necessary to ensure compliance in transactions between hospitals and physicians, as well as other parties with referral relationships within the healthcare environment.
