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

Description

As providers enter into new payment models, 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 laws provide several safe harbors and exceptions that shield healthcare providers from the prohibitions outlined by the AKS and Stark. These 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.

Counsel for healthcare providers and payers must consider the requirements of the AKS and Stark law and the safe harbors and exceptions when contracting with managed care companies and when structuring down-stream arrangements with providers. Counsel must 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 reviews the various AKS safe harbors potentially applicable to managed care arrangements and downstream provider arrangements. The presenters will address situations that trigger Stark concerns, examine the Stark exceptions for 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 payers on structuring arrangements to fit within the AKS safe harbors and Stark exceptions and the PIP rules for managed care contracting.