Structuring Physician Incentives: Regulatory Compliance, Avoiding Potential Pitfalls

Fair Market Value, Commercial Reasonableness, and Volume/Value of Referrals Considerations

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


Conducted on Thursday, June 6, 2019

Recorded event now available

or call 1-800-926-7926
Program Materials

This CLE webinar will guide healthcare counsel on physician incentives, examining the legal requirements and the potential risks. The panel will compare current incentives and value-based incentives and will discuss the impact on regulatory compliance. The panel will offer best practices for structuring physician incentives.

Description

The healthcare industry is steadily shifting from reimbursement based on volume of services to value of care provided. To keep pace with this shift, provider contracts and transactions increasingly include financial incentives to encourage coordinated efforts toward improvement on measures of value in care delivery. Although these types of financial incentives are reasonable and even necessary to achieve the needed changes in provider practices and behaviors, they are fraught with potential regulatory pitfalls.

Several recent Federal False Claims Act cases illustrate why incentives that are not carefully considered in the context of facts and circumstances can lead to legal troubles, particularly with the important regulatory “rules” of ensuring that financial arrangements are fair market value (FMV), commercially reasonable, and not improperly based on volume or value of referrals.

Listen as our authoritative panel of healthcare legal advisers discusses emerging trends in financial incentives for physicians and other providers and the pitfalls in properly documenting, structuring and implementing them.

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Outline

  1. Comparison of typical physician incentive arrangements historically vs. in the current environment
  2. The current and evolving regulatory environment and the dangers in improperly structured incentive arrangements in this environment, including:
    1. New (and unchanged) standards of what is FMV, commercially reasonable, and/or improperly based on volume or value of referrals; and
    2. Recent regulatory enforcement actions and court cases that are illustrative of the pitfalls of certain newer types of incentives, including those that on their face may seem reasonable.
  3. Observations and best practices for avoiding pitfalls in the design and structuring of incentive arrangements.

Benefits

The panel will review these and other key issues:

  • What steps can healthcare advisers take to ensure regulatory compliance when structuring physician incentives?
  • What are the implications for compliance with the Stark Law, the AKS, and other laws and regulations?
  • What lessons can healthcare counsel take away from recent enforcement actions?

Faculty

Ferrari, Andrea M.
Andrea M. Ferrari, JD, MPH

Partner
HealthCare Appraisers

Ms. Ferrari focuses on physician payments related to hospital physician alignment and efficiency improvement...  |  Read More

Jacobs, Clevonne
Clevonne M. (Vonne) Jacobs

Principal & Founder
PHAROS Healthcare Consulting

Ms. Jacobs provides strategic and operational advisory services to for-profit and nonprofit healthcare organizations....  |  Read More

Razdan, Neerja
Neerja Razdan
Associate Counsel
Beaumont Health

Ms. Razdan is Associate Counsel with the Beaumont Health. She has experience focusing on a wide range of physician and...  |  Read More

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CLE On-Demand Video

48 hours after event

$297

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48 hours after event

$297