COVID-19 Spotlight: Contract & Compensation Impacts
COVID-19 Spotlight: Leadership Best Practices
COVID-19 Spotlight: Stark Regulation Waivers
A compensation program is only as good as its design.
If you aren’t being proactive in creating a culture of compliance, the costs of being reactive are significant.
Are the administrators and compliance officers in charge of your physician contracts aware of the penalties for these violations?
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.
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.
Even healthcare organizations acting in good faith can sometimes run into issues with the Anti-Kickback Statute
Some overpayments are harder to spot–particularly when agreements are “stacked.”
A CIA is a tool implemented to strengthen an organization’s compliance program with government-approved policies and procedures.
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.
The two facilities are set to close in a few months, putting nearly 1,200 employees out of work.
The kickback allegations are in relation to orthopedic surgeon contracts for on-call emergency department rotation.
The False Claims Act imposes liability on people and organizations who defraud government programs.
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.
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.
While having an effective compliance program has always been best practice, it's more important than ever given the updated guidance.
The Department of Justice is enforcing individual responsibility for corporate wrongdoing.
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.
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.
With some recently released DOJ allegations, healthcare organizations can directly learn exactly what not to do when it comes to Stark and AKS
"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
Organizations that lack policies about when to pay for ED coverage run the risk of making decisions that aren’t always strategic.
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.
This week, let’s discuss the legislature related to the corporate practice of medicine.
The stricter an organization is about defining, determining, and documenting fair market value for every arrangement, the better.
Stark Law, or the Physician Self-Referral law, is a civil law that restricts physician self-referrals, including by family.
Physician contract compliance matters, first and foremost, because breaking federal law comes with hefty fines.
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.
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.
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.
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.
Pediatric facilities understandably have a specific set of patients and, as a result, they have different physician contracting needs than most hospitals.
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.
While these arrangements benefit patients, physicians and healthcare organizations, they are usually complex and require careful attention to payment and service requirements.
An internal audit can provide valuable information on contracting practices and identify opportunities to implement change.
The Anti-Kickback Statute (AKS) was enacted in 1972 to help protect the government from healthcare fraud and abuse.
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.
Benchmarks can change from year to year, significant shifts are uncommon.
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.
Recent settlements and advisories offer a number of lessons to help shape effective contract compliance programs.
Preparing for a physician contract negotiation? As you've likely discovered, these conversations take time and effort, and often go differently than anticipated.
Using market data to document fair market value for physician contracts can be a cost effective way to standardize compliance efforts.
MD Ranger data strongly suggests the benefits of multi-facility physician contracts as an important strategy for controlling costs.
Establishing a fair and compliant payment rate for a position that does not need a particular type of specialist can be a challenge!
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.
These tips can help shape a new physician contracting compliance program or refine an existing program.
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.
These tips will help shape a new physician contracting compliance program or refine an existing program.
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.
While making significant changes or implementing new policies requires time and slow approval processes, there are some tactical improvements you can make today.
Physicians can become suspicious when hospitals talk about FMV and think it’s an excuse for hospitals to pay them less.
Communication, even in the most positive relationships, can be challenging at times. What are the best practices for communicating with physicians?
Many healthcare organizations are full of physicians who have no idea what the compliance team does.
The best way to start engaging physicians in your compliance and legal programs is to get to know them.
Both parties have complimentary skill sets that are best used working together.
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.
In order to ensure that payments to physicians were in accordance with their agreement, auditors must work with finance, legal, and compliance.
Here are some quick tips to avoid stacking in the first place.
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.
Stacking has come to greater prominence following an OIG advisory opinion that defines problematic compensation structures.
We recently spoke with Gail Peace, CEO of Ludi, about how hospitals are managing physician contracts from both an operational and finacnial perspective
By Pascale Dargis, guest blogger from Ludi
We ask our Founder and EVP Michael Heil to answer the question
By using guidelines in CIAs for other healthcare entities similar to yours, you can mimic compliant program requirements.
The OIG is actively investigating potential regulatory violations at healthcare entities.
The Bipartisan Budget Act of 2015 mandated that federal agencies adjust civil monetary penalty amounts for inflation.
Some notable examples
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.
CIAs are designed to improve processes so that violations don’t occur again.
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.
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.
The purpose of a CIA is to strengthen an organization’s compliance program with policies and procedures approved by the government.
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.
In the event that you are audited, you will need to demonstrate that commercial reasonableness was carefully considered along with FMV.
The two most important regulations to understand are the Stark Law and the Anti-Kickback Statute.
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.
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.
A theme throughout the Compliance Institute was that shopping for FMV valuations conflicts with FMV being based on an “independent third party opinion”.
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.
In looking at numerous recent settlements, we can see that physician compensation is a hot topic for hospitals.
Living under and in compliance with a Corporate Integrity Agreement (CIA) is no easy task.
The Monday afternoon Communicating with Regulators and Enforcement: Avoiding Pitfalls session gave a glimpse into the mind of regulators and prosecutors.
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.
As a foundation, there are seven essential elements a compliance program should have
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).
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.
Whatever method, document the rationale and approval process and stick to a consistent method.
Organizations must document all contractual arrangements with physicians, with payment terms set in advance that are unrelated to volume of services.
Board oversight of physician contracts is an important component of a strong compliance program.
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.
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.
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.
MD Ranger produces reports that compare each physician contract that a subscriber has to the benchmarks.
Most physician payment rates fall within a reasonable market range. But in some cases, a payment rate may be well beyond the norm.
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.