Clinically Integrated Networks in a Value-Based Care World and the New Regulatory Landscape: What You Need To Know
Legal and Regulatory Issues for CINs, Organizational Structure, Governance, and More
Recording of a 90-minute CLE video webinar with Q&A
This CLE course will address legal, regulatory and market changes that are important to the future formation and operation of hospital-physician clinically integrated networks (CINs) and Accountable Care Organizations (ACOs). The topics will include recent regulatory activity and changes in key aspects of federal and state antitrust law, healthcare fraud and abuse laws, information privacy and data sharing regulations, corporate practice of medicine and fee splitting restrictions, and state and federal tax law. The course will provide an opportunity for Q&A to allow listeners to focus the discussion on what is most relevant to them.
Outline
- Overview of selected key recent and proposed changes and case law developments in Federal and state antitrust law, healthcare fraud and abuse laws, payor regulations, information privacy and data sharing, corporate practice of medicine restrictions, and state and federal tax law
- Current and future organizational and governance issues in the evolving regulatory environment, including issues related to monitoring and maximizing participant financial incentives while ensuring compliant, fair market value and commercially reasonable payments
- What can be learned from recent case law and examples in the market
- Suggestions for best practices going forward, including for information tracking and payments of incentives and distributions
Benefits
The panel will review these and other key issues:
- Regulatory and compliance questions CINs face under new Federal and state laws and regulations, including the physician self-referral, anti-kickback, antitrust, corporate practice of medicine, fee splitting and tax exemption laws and regulations
- Factors healthcare providers and their counsel should consider when selecting and managing value-based population health incentive programs in 2023
- When and why contributions to and payments from a CIN should be evaluated for fair market value and reasonableness
- Special considerations when CIN participants are hospital-employed physicians, not-for-profit entities and/or private equity investors
Faculty
Lara D. Compton
Member
Mintz Levin Cohn Ferris Glovsky and Popeo
Ms. Compton is a trusted advisor to clients ranging from traditional health care providers to disrupter digital health... | Read More
Ms. Compton is a trusted advisor to clients ranging from traditional health care providers to disrupter digital health platforms as they navigate the practical and regulatory challenges of health care innovation. She counsels telemedicine and other digital health clients on business plan strategy and implementation, state-specific telemedicine regulation, corporate practice of medicine, the scope of practice, fee splitting, anti-kickback, reimbursement, and other health care regulatory issues. Leveraging her prior in-house experience at two nonprofit health systems, Ms. Compton also advises health care providers on the incorporation of telehealth and other technology infrastructures, which has seen a vast uptick as a result of the COVID-19 pandemic. She advises health care providers, clinical trials companies, ancillary providers, technology start-ups, HMOs, insurance companies, and large technology companies on HIPAA and other health data privacy and security regulations, including developing and implementing HIPAA compliance programs. She has also led significant HIPAA breach investigations, advising clients on risk management and mitigation efforts.Member
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Andrea M. Ferrari, JD, MPH
Principal and General Counsel
Pinnacle Healthcare Consulting
Ms. Ferrari has more than 25 years of experience in the healthcare industry in various counsel, consulting and... | Read More
Ms. Ferrari has more than 25 years of experience in the healthcare industry in various counsel, consulting and leadership roles. She serves clients inside and outside of Pinnacle, providing assistance with compliance strategy, risk management, due diligence, investigations, and litigation.
Her practice experience is national in scope and includes providing transactional, operational, governance, and dispute resolution support for a broad array of nonprofit, for-profit, and governmental clients, including hospitals and health systems, physicians and physician groups, clinical laboratories, and pharmaceutical and medical device vendors, distributors, and manufacturers. She has assisted clients with structuring, documenting, managing, and, when appropriate, defending financial arrangements involving healthcare providers, often with attention to requirements and implications of the Stark Law, Anti-kickback Statute, False Claims Act, non-profit tax regulations, Foreign Corrupt Practices Act and/or the various state laws concerning billing, payment and corporate practice of medicine. Her work has included assisting clients with mergers and acquisitions, affiliations, joint ventures, public-private partnerships, enterprise-level compliance programs, and healthcare workforce recruitment and management arrangements, including significant incentive, independent contractor, and employment arrangements that exceed $1 million in annual compensation. Her work has also included outside general and special counsel services for healthcare clients, focusing on their contracting and compensation practices.
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Mark C. Watson
Partner
Hancock Daniel
Mr. Watson focuses on the representation of various providers, including hospitals, health systems, physician groups,... | Read More
Mr. Watson focuses on the representation of various providers, including hospitals, health systems, physician groups, ambulatory surgery centers, and post-acute care providers, in connection with various transactional, operational, and regulatory matters. He handles transactional matters, including merger and acquisitions of healthcare entities. He also represents health system, hospitals and provider groups in the development and implementation of clinical integration strategies, including the formation of multiple clinically integrated networks taking on a variety of structures, including wholly-owned subsidiaries, hospital-physician joint ventures, and physician-owned networks.
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