New 2016 Work Plan Indicates Area of Compliance Focus

OIG 2016 Work Plan Highlights Areas of Fraud and Abuse Concern Each year the Office of Inspector General puts out a work plan that indicates the priorities that it will look up at during the upcoming year. The OIG is an organization that was created to protect the integrity of the HHS program ope...

Ambulatory Surgery Center Forced Exclusions – lets be honest for a minute, shall we?

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 pol...

Definition of Remuneration Under the Federal Stark Law

Remuneration – Definition Under The Stark Law 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 for inacc...

Medical Director Agreement Payments May Be Source of Stark Law Compliance Concerns

MEDICAL DIRECTOR PAYMENTS AS STARK LAW VIOLATIONS The relatively recent case serves as a reminder of the potential exposure to Stark Law liability arising from payments to medical directors.  Let me immediately clarify that not all payments to directors who perform legitimate services that are a...

Special Rules on Compensation Stark Law

Stark Regulations Special Rules On Compensation (d) Special rules on compensation. The following special rules apply only to compensation under section 1877 of the Act and subpart J of this part: (1) Compensation is considered “set in advance” if the aggregate compensation, a time-based or per-un...

Stark Law Regulations – Definition of Financial Arrangment

Stark Law Definition of Financial Relationship Under Stark Regulations Sec. 411.354 Financial relationship, compensation, and ownership or investment interest. (a) Financial relationships. (1) Financial relationship means– (i) A direct or indirect ownership or investment interest (as defined in p...

Fair Market Value and Physician Compensation – Stark Law

Fair Market Value Stark Law Regulatory Definition A number of areas of the Stark Law, Stark Regulations and comments to proposed and final rules discuss the concept of fair market value in connection with physician compensation.  I thought it might be useful to post some of the statutory and reg...

60 Day Repayment Rule False Claims Act

The 60-Day Repayment Rule and False Claims Act Providers Get Another Push Into Proactive Compliance The Patient and Program Protection Act (“PPACA”) added a number of additional tools to the government’s fraud fighting arsenal.  One of those tools is found in PPACA Section 6402 and require...