Anti-Kickback Statute and New Stark Law Compliance in Managed Care Contracts

Navigating Safe Harbors and Physician Incentive Plan Rules, Limiting Civil Monetary Penalty Exposure

Recording of a 90-minute CLE webinar with Q&A


Conducted on Thursday, November 10, 2016

Recorded event now available

or call 1-800-926-7926
Program Materials

This CLE webinar will provide guidance to healthcare counsel on ensuring compliance under the Anti-Kickback Statute (AKS) and new Stark law. The panel will also provide best practices for counsel on structuring arrangements to fit within the AKS safe harbors and Stark exceptions and the PIP rules for managed care contracting.

Description

Healthcare reform is driving fundamental changes in the relationship between providers and managed care companies. Further, the federal government continues its focus on reigning in healthcare fraud, including ensuring provider compliance with the AKS and Stark law. The AKS and Stark law provide several safe harbors and exceptions that shield healthcare providers from the prohibitions outlined by the AKS and Stark. Safe harbors, such as those for eligible managed care organizations, create flexibility in managed care contracting and allow payment arrangements that could otherwise present a risk of violating the AKS.

In Nov. 2015, the Centers for Medicare and Medicaid Services (CMS) published the most significant changes to the Stark law since 2008. The amendments establish new exceptions and clarify existing exceptions and requirements and took effect Jan. 1, 2016. The changes include new exceptions related to recruitment for non-physician practitioners and certain timeshares.

Counsel for healthcare providers and payors must keep in mind the requirements of the AKS and Stark law and the safe harbors and exceptions when contracting with managed care companies. Counsel should also understand when physician incentive payments are subject to Civil Monetary Penalty (CMP) Statute liability, or conversely, are protected under the PIP rules.

Listen as our authoritative panel of health law counsel examines the various AKS safe harbors potentially applicable to managed care arrangements. The panel will address when Stark is implicated, examine the Stark exceptions aimed at managed care arrangements and safe harbors, and discuss the CMP Statute and the PIP rules. The panel will also outline guidance for counsel to healthcare providers and payors on structuring arrangements to fit within the AKS safe harbors and Stark exceptions and the PIP rules for managed care contracting.

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Outline

  1. Application of the AKS, the Stark law and the safe harbors
  2. Physician incentive plan rules
  3. Civil monetary penalty exposure

Benefits

The panel will review these and other key issues:

  • What risk-sharing arrangement between a managed care organization and physician does not constitute a financial arrangement under Stark?
  • What is the scope of the AKS and Stark safe harbors?
  • What are the exceptions in AKS and Stark that create flexibility for managed care contracting?

Faculty

Donald H. Romano
Donald H. Romano

Of Counsel
Foley & Lardner

Mr. Romano has extensive experience counseling hospitals, skilled nursing facilities and academic medical centers and...  |  Read More

Waxman, J. Mark
J. Mark Waxman

Partner
Foley & Lardner

Mr. Waxman chairs the firm's Health Care Industry Team. He focuses on healthcare issues and handles issues...  |  Read More

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Strafford will process CLE credit for one person on each recording. All formats include program handouts. To find out which recorded format will provide the best CLE option, select your state:

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