MD Ranger attended the 20th Annual Health Care Compliance Association Compliance Institute from April 17-20th. We look forward to this event as it allows us to meet the best and brightest in the compliance field.
Didn’t have a chance to attend the conference, or didn’t make the presentations you wanted to see? Don’t worry: we’ve summarized our key take-aways so that you can catch up in seven minutes or less.
1. Everyone’s talking about the Yates Memo.
It seems like the hottest topic of 2016 is the Yates Memo. In 2015, the OIG issued a Fraud Alert warning physicians that they assume personal risk under the Anti-Kickback Statute for noncompliant compensation arrangements. In 2015, Columbus Regional and Dr. Andrew Pippas settled for $35 million and $425,000 respectively to resolve allegations of violations of the False Claims Act and Stark Law. Personal accountability has officially taken the spotlight.
2. Commercial reasonableness is important (yet difficult to establish).
The necessity of physician arrangements being commercially reasonable is not new; however, in recent settlements commercial reasonableness has come up repeatedly. If you cannot make a sound business case for paying a physician without accounting for referrals, you should reconsider compensation. However, most organizations struggle with determining commercial reasonableness. If you need help too, speak with MD Ranger experts at firstname.lastname@example.org.
3. The ACA turned the heat up on healthcare fraud.
Given provisions within the Affordable Care Act, the DOJ is targeting healthcare fraud more than ever. The government placed focused resources on hotbed cities like Miami, Tampa, Baton Rouge, Dallas, Brooklyn, Detroit, Chicago, and Los Angeles. In addition, the DOJ has hired a compliance specialist, demonstrating the importance of compliance to the agency.
4. False Claims Act: The Third Musketeer?
Over the past few years we’ve seen the False Claims Act emerge as a player in physician compensation-related settlements. Today, FCA is as prominent as Stark and AKS in these cases. The experts who spoke on the topic seem to think that the FCA will continue to be a liability for organizations. This is especially worrisome for hospitals, since the FCA substantially increases penalties.
5. Creating a simplified physician contract process is more critical than ever.
Several speakers focused on the importance of not just having a compliance program, but one that is easy to follow. Your process should be composed of straightforward policies and procedures. Instead of having different compensation frameworks for each physician contract, try sticking to one or two templates to more easily monitor compliance.
6. Collaboration between legal, compliance, and accounts payable functions is essential for physician contract compliance.
Legal, compliance, or finance departments often oversee physician contracting in silos. Physician contracting should be a collaboration between departments. Legal may write the contract, while compliance may check to be sure it isn’t violating Stark or AKS. Don’t forget accounts payable, which plays a key role in checking to be sure the payments are within the terms of the agreement. Regardless of who owns what, communication and collaboration are key.
If you would like to read more about the sessions we attended, check out the HCCA section of our blog.