CMS Stark Law Self Disclosure – New Form and Process for Self Disclosing Stark Law Violations

The Centers for Medicare and Medicaid Services (CMS) has issued new forms and procedures for provider self-disclosure of Stark Law violations. The new material is intended to streamline the process that permits providers to self-disclose Stark Law violations.  The process is applicable to violat...

Remuneration Under the Stark Law I Stark Regulations Definition

Remuneration Defined Under the Stark Law Regulations Remuneration means any payment or other benefit made directly or indirectly, overtly or covertly, in cash or in kind, except that the following are not considered remuneration for purposes of this section: (1) The forgiveness of amounts owed fo...

Designated Health Services Definition I Stark Law DHS Defined

Definition of Designated Health Services under the Stark Law Regulations Designated health services (DHS) means any of the following services (other than those provided as emergency physician services furnished outside of the U.S.), as they are defined in this section: (1)(i) Clinical laboratory ...

Can Overpayments Create Criminal Liability?

We hear a lot about potential liability under the False Claims Act (FCA) for the failure to repay overpayments within 60 days of discovery. Focus on the 60-day rule has taken focus away from the potential for criminal charges for retaining known overpayments.  Section 1128B(a)(3) of the Social S...

Defining the Duty of the Board of Directors over Compliance Functions

Compliance Program Oversight by Board of Directors I recently posted a blog article about a document released by the Department of Justice entitled “Evaluation of Compliance Programs.”  As the title of the document might suggest, the DOJ release covers a variety of issues it looks at when ev...

Self Disclosure Process – Voluntary Self Disclosure Decisions are not Always Easy

Provider Self Disclosure Decisions – Voluntary Disclosure Process The HHS Office of Inspector General offers providers and opportunity to self-disclose certain violations in exchange for avoiding some of the more draconian penalties that may otherwise apply under applicable regulations.  Even ...

Ambulatory Surgery Center Exclusions – ASC Safe Harbor Compliance

Excluding Non-performing Positions from a Physician Owned Surgery Center Many surgery centers are eventually faced with decisions about how to treat investing physicians who do not perform as many procedure procedures in the surgery center as others.  Under-performing physicians can create polit...

Fair Market Value Definition – Stark Law and Safe Harbor Regulations

Stark Law Definition of Fair Market Value The term “fair market value” means the value in arm’s-length transactions, consistent with the general market value. ‘‘General market value’’ means the price that an asset would bring, as the result of bona fide bargaining between well-infor...

Revision to Medicare oversight or provider based status.

Hospital Provider Based Status Review OIG 2016 Work Plan Coverage   There’s a lot of activity in the area of provider based facilities and hospitals outpatient departments. Laws are changing to equalize reimbursement that is available between provider-based and physician office settings. Service...