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Compliance

Compliance
COVID-19 Spotlight

Video Spotlight: Contract & Compensation Impacts

COVID-19 Spotlight: Contract & Compensation Impacts

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Posted on
September 25, 2020
COVID-19 Spotlight
Compliance

Video Spotlight: Leadership Best Practices

COVID-19 Spotlight: Leadership Best Practices

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Posted on
August 20, 2020
COVID-19 Spotlight
Compliance

COVID-19 Stark Regulation Waivers

COVID-19 Spotlight: Stark Regulation Waivers

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Posted on
July 8, 2020
Compliance

Critical Judgement a Must When Designing Physician Compensation Programs

A compensation program is only as good as its design.

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Posted on
March 13, 2020
Compliance

Top 5 Lessons to Learn from Sutter’s Historic $46 Million Settlement

If you aren’t being proactive in creating a culture of compliance, the costs of being reactive are significant.

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Posted on
February 25, 2020
Compliance

Risk Management Series: 5 Questions to Ask Yourself

Are the administrators and compliance officers in charge of your physician contracts aware of the penalties for these violations?

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Posted on
December 14, 2019
Compliance

Risk Management Series : Qui Tam Provisions

Under the FCA, any individual has the right to sue an entity they believe to have committed fraud against the government–and to recover funds on their behalf.

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Posted on
November 6, 2019
Compliance

Risk Management Series: Why you need to care about Stark Law, the Anti-Kickback Statute, and the False Claims Act

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Posted on
October 10, 2019
Compliance

Risk Management Series: Individual Accountability in Corporate Wrongdoing

Late last year, former US Deputy Attorney General Rod J. Rosenstein announced the Department of Justice’s (DOJ) intent to focus on individual wrongdoers in corporate investigations.

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Posted on
October 3, 2019
Compliance

Feds Charge Amity Home Health Care and Advent Care in $115M Medicare Kickback Scheme

Even healthcare organizations acting in good faith can sometimes run into issues with the Anti-Kickback Statute

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Posted on
September 6, 2019
Compliance

How to Mitigate Stacking Risks

Some overpayments are harder to spot–particularly when agreements are “stacked.”

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Posted on
September 5, 2019
Compliance

The Ins and Outs of CIA's

A CIA is a tool implemented to strengthen an organization’s compliance program with government-approved policies and procedures.

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Posted on
August 27, 2019
Compliance

How to Address Benchmark Shifts

Several factors play a role in shifting benchmarks from year to year. By understanding why these benchmarks change from year to year, you can adapt your compliance plan to prepare for change.

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Posted on
August 22, 2019
Physician Contract Strategy
Compliance

In Wake of Wheeling Lawsuit, Two Hospitals to Close in Ohio, West Virginia

The two facilities are set to close in a few months, putting nearly 1,200 employees out of work.

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Posted on
August 14, 2019
Compliance
ED Call Coverage

Broward Health Settles With Former CEO

The kickback allegations are in relation to orthopedic surgeon contracts for on-call emergency department rotation.

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Posted on
August 6, 2019
Compliance

2019 Mid-Year False Claims Update: What does it mean for you?

The False Claims Act imposes liability on people and organizations who defraud government programs.

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Posted on
July 24, 2019
Compliance

Encompass Health Settles False Claims Allegations with DOJ

One way hospitals and health systems can mitigate compliance risk is to promote organization-wide compliance policies and procedures with buy-in from executives, administrators, and physicians.

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Posted on
July 10, 2019
Physician Contract Strategy
Compliance

What Influences Physician Contract Rates?

As part of our 10th anniversary series, we’re taking a closer look at the key factors that influence physician payment rates based on our analysis of our 2019 benchmarks.

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Posted on
June 24, 2019
Compliance

DOJ Updates Evaluation of Corporate Compliance Program Guidance

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Posted on
June 4, 2019
Compliance
Physician Contract Strategy

DOJ Updates Evaluation of Corporate Compliance Program Guidance

While having an effective compliance program has always been best practice, it's more important than ever given the updated guidance.

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Posted on
June 4, 2019
Compliance

Individual Culpability Still on the Minds of the Feds

The Department of Justice is enforcing individual responsibility for corporate wrongdoing.

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Posted on
May 9, 2019
Compliance
Cost Management
ED Call Coverage
COVID-19 Spotlight
For Physicians

2019 Benchmarks Reveal Physician Pay Trends

Our 2019 report highlights the growing significance of physician contracts as a major component of hospital spending, with particular growth in payment for hospital-based physician services such as hospitalists, intensivists and laborists.

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Posted on
April 18, 2019
Compliance

Evaluating Stacked Agreements: Case Studies

Overpayments can be hidden—particularly when there is “stacking” of physician agreements that results in total payments to an individual or group exceeding reasonable levels.

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Posted on
April 5, 2019
Compliance

Stark Law and AKS: What Not To Do

With some recently released DOJ allegations, healthcare organizations can directly learn exactly what not to do when it comes to Stark and AKS

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Posted on
March 29, 2019
Compliance

Changes to Stark Law on the Horizon?

"Outdated policies from HHS mean not only less than desirable results for taxpayers and for beneficiaries of our programs, but often for patients and payers in the private market as well. The role played in paying for services by our own policies at HHS is dominant, which means where we aren't innovating, we hold things back." - Deputy HHS Secretary Eric Hargan

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Posted on
January 31, 2019
Compliance
ED Call Coverage
Physician Contract Strategy

Make a Call Coverage Payment Strategy

Organizations that lack policies about when to pay for ED coverage run the risk of making decisions that aren’t always strategic.

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Posted on
December 21, 2018
Compliance 101
Compliance

Fair Market Value

Paying a physician within fair market value range for their services is a key component of what it means for an arrangement to be compliant.

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Posted on
December 7, 2018
Compliance 101
Compliance

Corporate Practice of Medicine Laws

This week, let’s discuss the legislature related to the corporate practice of medicine.

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Posted on
November 9, 2018
Compliance 101
Compliance

What is the Anti-Kickback Statute?

The stricter an organization is about defining, determining, and documenting fair market value for every arrangement, the better.

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Posted on
November 2, 2018
Compliance

What is Stark Law?

Stark Law, or the Physician Self-Referral law, is a civil law that restricts physician self-referrals, including by family.

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Posted on
October 26, 2018
Compliance

Why Compliance Matters

Physician contract compliance matters, first and foremost, because breaking federal law comes with hefty fines.

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Posted on
October 19, 2018
Compliance
Physician Contract Strategy

Congress Considers Changes to Stark and AKS

The Department of Health and Human Services announced a “regulatory sprint to coordinated care” in June 2018, a new initiative to remove regulatory barriers that impede the transition to a coordinated, value-based health delivery system.

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Posted on
September 12, 2018
Compliance

Selecting a Valuation Firm – Identifying a Good Cultural Fit

In order to ensure that you are getting the quality opinions you require, you should be working with experts who understand your organization’s unique needs.

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Posted on
August 21, 2018
Compliance

CIAs: What You Need to Know

The purpose of a CIA is to strengthen an organization’s compliance program with policies and procedures approved by the government. The OIG must have confidence that the organization is taking steps to prevent new violations.

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Posted on
August 14, 2018
Compliance

Commercial Reasonableness: Testing and Documentation

Many recent settlements for Stark and Anti-Kickback violations stem from failure to meet commercial reasonableness standards or from lack of documentation of an agreement’s commercial reasonableness.

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Posted on
July 31, 2018
Medical Direction Contracts
Hospital-Based
ED Call Coverage
Compliance
Uncategorized

How Children's Hospitals Differ from General Acute Care Facilities

Pediatric facilities understandably have a specific set of patients and, as a result, they have different physician contracting needs than most hospitals.‍

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Posted on
July 3, 2018
Uncategorized
Compliance
ED Call Coverage

Trends in General Surgery Call Coverage

While cases where physician compensation benchmarks change rapidly from year to year certainly garner more attention, it can be insightful to examine when the opposite is true as well.

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Posted on
June 26, 2018
Hospital-Based
Physician Contract Strategy
Compliance

Mistakes to Avoid in Hospital-Based Physician Contracts

While these arrangements benefit patients, physicians and healthcare organizations, they are usually complex and require careful attention to payment and service requirements.

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Posted on
June 21, 2018
Compliance

Best Practices for Physician Contract Audits

An internal audit can provide valuable information on contracting practices and identify opportunities to implement change.

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Posted on
June 19, 2018
Compliance

What You Need to Know about the Anti-Kickback Statute

The Anti-Kickback Statute (AKS) was enacted in 1972 to help protect the government from healthcare fraud and abuse.

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Posted on
June 14, 2018
Compliance
Cost Management
ED Call Coverage

Alternatives to Per Diem Payments for Call Coverage

Over the past decade, spending for physician expenditures as a percent of total hospital operating expenditures has grown over 40% according to OSHPD data. Costs will escalate when a hospital starts to compensate one specialty, which will create a domino effect with others.

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Posted on
June 12, 2018
Understanding Market Data
Compliance

Why Benchmarks Change

Benchmarks can change from year to year, significant shifts are uncommon.

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Posted on
June 5, 2018
Compliance
Hospital-Based

Contracting for Pediatric Services? Read This First.

Many community healthcare organizations address this need by contracting with a children’s hospital or academic medical center. Several specialty physician companies also provide pediatric physician services.

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Posted on
May 31, 2018
Compliance
Physician Contract Strategy
Cost Management

Easy Ways to Improve Physician Contract Compliance

Recent settlements and advisories offer a number of lessons to help shape effective contract compliance programs.

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Posted on
May 24, 2018
Compliance
For Physicians
Physician Contract Strategy

7 Tips for Effective Contract Negotiations

Preparing for a physician contract negotiation? As you've likely discovered, these conversations take time and effort, and often go differently than anticipated.

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Posted on
May 22, 2018
Understanding Market Data
Compliance

Finding the Best Market Range for FMV

Using market data to document fair market value for physician contracts can be a cost effective way to standardize compliance efforts.

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Posted on
May 10, 2018
ED Call Coverage
Medical Direction Contracts
Compliance
Cost Management

Multi-Campus Physician Contracts: Impact on Payment Rates and Time Requirements

MD Ranger data strongly suggests the benefits of multi-facility physician contracts as an important strategy for controlling costs.

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Posted on
May 8, 2018
Compliance
Cost Management

When Specialty Doesn't Matter, How Much Should You Pay?

Establishing a fair and compliant payment rate for a position that does not need a particular type of specialist can be a challenge!

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Posted on
April 26, 2018
Compliance

Federal Regulations and the Risk to Physicians

The OIG published a Fraud Alert, which warns physicians that they could take on personal risk under the Anti-Kickback Statute for noncompliant compensation arrangements.

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Posted on
April 19, 2018
Compliance

Five Can't Miss Physician Contracting Compliance Tips

These tips can help shape a new physician contracting compliance program or refine an existing program.

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Posted on
April 17, 2018
Compliance
Understanding Market Data
For Physicians

Addressing Outlier Physician Payments

Understanding how outliers affect market data and what to do if your contract falls outside market ranges is an important aspect of a physician contracting compliance program.

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Posted on
April 12, 2018
Compliance

Physician Compliance Tips You Can't Miss

These tips will help shape a new physician contracting compliance program or refine an existing program.

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Posted on
April 8, 2018
Compliance
Physician Contract Strategy

Five Tips for Making Physician Contracting More Efficient

MD Ranger subscribers are constructing order out of the complex processes of contract organization, negotiation, and approvals by creating a more structured, efficient, and informed system. Physician contracting and documenting FMV doesn’t have to be an expensive headache.

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Posted on
April 3, 2018
Compliance

Compliance Tips You Can Use Today For Big Impact

While making significant changes or implementing new policies requires time and slow approval processes, there are some tactical improvements you can make today.

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Posted on
March 22, 2018
Compliance
For Physicians

How to Talk to Physicians about Compensation as it Relates to Compliance

Physicians can become suspicious when hospitals talk about FMV and think it’s an excuse for hospitals to pay them less.

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Posted on
January 30, 2018
Compliance

Communicating a Culture of Compliance with Your Medical Staff

Communication, even in the most positive relationships, can be challenging at times. What are the best practices for communicating with physicians?

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Posted on
January 23, 2018
Compliance

What’s the Best Way to Educate Doctors about Compliance? Written by Allison Pullins on January 16, 2018.

Many healthcare organizations are full of physicians who have no idea what the compliance team does.

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Posted on
January 16, 2018
Compliance
Compliance 101

Physician Compliance Engagement 101: Getting Docs Involved

The best way to start engaging physicians in your compliance and legal programs is to get to know them.

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Posted on
January 9, 2018
Compliance

Compliance and Legal Make a Great Team

Both parties have complimentary skill sets that are best used working together.

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Posted on
January 2, 2018
Compliance
For Physicians

Ignoring Physicians in Your Compliance Program is a Bad Idea

If you’re a compliance officer or work in compliance or legal at your organization, ask yourself if you know any physicians who work at your hospital.

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Posted on
December 26, 2017
Compliance

Perform Annual Contract Audits to Remain in Compliance

In order to ensure that payments to physicians were in accordance with their agreement, auditors must work with finance, legal, and compliance.

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Posted on
December 12, 2017
Compliance

Best Practices to Avoid Stacking

Here are some quick tips to avoid stacking in the first place.

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Posted on
December 5, 2017
Cost Management
Compliance

Catching Hidden Overpayments in Physician Agreements: Stacking Risks

Risks for overpayments are things like paying above FMV, or paying for too many hours per administrative deal are straightforward to discover with careful review and analysis of contracts.

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Posted on
November 28, 2017
Compliance
Cost Management

Stacking – Risks and Prevention

Stacking has come to greater prominence following an OIG advisory opinion that defines problematic compensation structures.

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Posted on
November 21, 2017
Compliance
Cost Management

Operational and Financial Management of Physician Agreements

We recently spoke with Gail Peace, CEO of Ludi, about how hospitals are managing physician contracts from both an operational and finacnial perspective

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Posted on
September 12, 2017
Compliance

Reasons Your Physician Contracts Need Long-Term Attention

By Pascale Dargis, guest blogger from Ludi

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Posted on
August 15, 2017
Compliance

If a Service Doesn't Implicate Stark Law, How Do You Determine FMV?

We ask our Founder and EVP Michael Heil to answer the question

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Posted on
April 3, 2017
Compliance

Use Other Organizations' CIAs to Create Your Processes

By using guidelines in CIAs for other healthcare entities similar to yours, you can mimic compliant program requirements.

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Posted on
January 17, 2017
Compliance

Avoiding a CIA: Take Steps to Prevent Violations

The OIG is actively investigating potential regulatory violations at healthcare entities.

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Posted on
January 10, 2017
Compliance

The Stakes are Higher: Penalties for Violations Increase

The Bipartisan Budget Act of 2015 mandated that federal agencies adjust civil monetary penalty amounts for inflation.

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Posted on
January 3, 2017
Compliance

2016 Settlements and Legal Action of Note

Some notable examples

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Posted on
December 27, 2016
Compliance

Yates Memo, Yates Memo, Yates Memo

In September 2015, Sally Yates, an attorney for the DOJ wrote a memo stating that individuals were to be held accountable in corporate wrongdoing cases.

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Posted on
December 20, 2016
Compliance

So, You're Being Faced with a CIA...

CIAs are designed to improve processes so that violations don’t occur again.

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Posted on
December 13, 2016
Compliance

No Joke: Personal Liability in a Post-Yates Memo Era

In September 2015, we first heard of the Yates memo and were warned that the DOJ was going to take individual accountability in corporate wrongdoing seriously. We have seen fines against individual physicians, but now we know hospital executives can no longer ignore the risks.

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Posted on
December 1, 2016
Compliance

What Do Corporate Integrity Agreements Require?

CIAs are fairly uniform; however, most include specific requirements tailored to the violation(s) that led to the settlement. CIAs typically run 3-5 years.

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Posted on
November 29, 2016
Compliance

What You Need to Know About Corporate Integrity Agreements (CIAs)

The purpose of a CIA is to strengthen an organization’s compliance program with policies and procedures approved by the government.

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Posted on
November 22, 2016
Compliance

Prepare for and Document the Negotiation Conversations

After building a case for why the organization needs the physician and role in question, prepare for the negotiation conversation. Anticipate where there will be pushback and where compromises can occur. Then, be sure to organize and document everything, this will save you a headache at a later date.

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Posted on
November 15, 2016
Compliance

Documenting Commercial Reasonableness

In the event that you are audited, you will need to demonstrate that commercial reasonableness was carefully considered along with FMV.

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Posted on
October 25, 2016
Compliance

How Can You Protect Your Organization from AKS Violations?

The two most important regulations to understand are the Stark Law and the Anti-Kickback Statute.

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Posted on
August 17, 2016
Compliance

Key Stark Law Developments: What Every Compliance Officer Needs to Know

In cases of compliance infractions, courts consider all the relevant facts in including commercial reasonableness of an arrangement and whether or not an organization made a good faith effort to comply.

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Posted on
June 22, 2016
Compliance

HCCA 2016: Updates from the OIG and DOJ

Each year, Dan Levinson provides HCCA’s attendees with a glimpse into what the OIG has occurred within the OIG recently and what they will be focusing on over the next year.

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Posted on
April 26, 2016
Compliance
Cost Management
Salary and Productivity

HCCA 2016: DOJ and OIG Focus on Physician Compensation

A theme throughout the Compliance Institute was that shopping for FMV valuations conflicts with FMV being based on an “independent third party opinion”.

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Posted on
April 26, 2016
Compliance

HCCA 2016: Physician Arrangement Integrity

Stark Law has recently hit the healthcare spotlight and is often framed as fraud. Though fraudulent arrangements do exist, Stark also leaves no margin for simple error due to structure as an exception statute.

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Posted on
April 22, 2016
Cost Management
Compliance

HCCA 2016: Physician Compensation Under the Microscope: Lessons Learned from Recent Settlements

In looking at numerous recent settlements, we can see that physician compensation is a hot topic for hospitals.

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Posted on
April 21, 2016
Compliance
HCCA

HCCA 2016: CIAs: Tips on Avoiding, Complying and Negotiating Them

Living under and in compliance with a Corporate Integrity Agreement (CIA) is no easy task.

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Posted on
April 20, 2016
Compliance
HCCA

HCCA 2016: Compliance in the Country: Considerations for Critical Access and Rural Hospitals

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Posted on
April 19, 2016
Compliance
HCCA

HCCA 2016: Communicating with Regulators and Enforcement: Avoiding Pitfalls

The Monday afternoon Communicating with Regulators and Enforcement: Avoiding Pitfalls session gave a glimpse into the mind of regulators and prosecutors.

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Posted on
April 19, 2016
Compliance
HCCA

HCCA 2016: The Stark Trifecta: How Legal, Compliance, and Outside Counsel Work Together on Stark Compliance

Our speakers pulled together a fun, scripted case study to demonstrate how internal legal, compliance, and outside counsel can successfully work together to handle Stark-related risks and issues.

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Posted on
April 19, 2016
Compliance
HCCA

HCCA 2016: Compliance Program Start Up: What are the Basics Needed for your Infrastructure

As a foundation, there are seven essential elements a compliance program should have

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Posted on
April 18, 2016
Compliance
For Physicians

Get Into the OIG’s Mind: Review Recent CIAs.

If you are overwhelmed by physician contracting compliance, or are unsure what elements are essential in a good compliance process, a great way to create structure is to review requirements outlined in recent corporate integrity agreements (CIAs).

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Posted on
April 10, 2016
Compliance
Physician Contract Strategy

Do You Have Guidelines for Handling Exceptional Physician Agreements?

When your organization determines it must compensate a physician above your standard for fair market value, create a standardized process for reviewing such exceptional contracts.

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Posted on
April 5, 2016
Compliance

Create a Rigorous, Consistent Process for Determining FMV

Whatever method, document the rationale and approval process and stick to a consistent method.

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Posted on
March 29, 2016
Compliance
Physician Contract Strategy

Does Every Physician Position at Your Organization Have a Contract?

Organizations must document all contractual arrangements with physicians, with payment terms set in advance that are unrelated to volume of services.

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Posted on
March 22, 2016
Compliance

The Hospital Board's Role in Compliance

Board oversight of physician contracts is an important component of a strong compliance program.

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Posted on
February 25, 2016
Compliance

Recent OIG Action Summary

The OIG actions of the past two years illustrate the risks of noncompliant contracts to healthcare organizations and individuals who do not have a comprehensive compliance program for review and documentation of physician contracts.

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Posted on
February 10, 2016
Compliance

FMV is not the end of the road, you still have to enforce the contracts

When our subscribers ask about physician contract compliance best practices, we caution them to be sure that the annual payment, the hourly rate, and the hours of service are compliant, and that contract performance and payments are tracked.

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Posted on
December 1, 2015
Compliance

Federal Regulations and the Risk to Physicians

Recent actions by the OIG make it clear that they are investigating physicians as well as hospitals when they suspect a physician contract violates Stark, Anti-Kickback, or False Claims Act regulations.

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Posted on
September 4, 2015
Compliance
Physician Contract Strategy

Auditing Contracts with Contract-to-Benchmark Comparisons

MD Ranger produces reports that compare each physician contract that a subscriber has to the benchmarks.

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Posted on
August 14, 2015
Compliance
Physician Contract Strategy

Defining Outlier Payments and Negotiating Compensation

Most physician payment rates fall within a reasonable market range. But in some cases, a payment rate may be well beyond the norm.

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Posted on
August 11, 2015
Compliance
Cost Management
Understanding Market Data

Evaluating Physician Compensation Survey Quality

Most physician payment rates fall within a reasonable market range. But in some cases, a payment rate may be well beyond the norm. These unusual payment rates, which can sometimes impact benchmark calculations, are outliers.

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Posted on
August 4, 2015