Due Diligence for Compensation Compliance: Mitigating Risk in Financial Relationships and Healthcare Transactions

Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
Intermediate
- work Practice Area
Health
- event Date
Wednesday, October 23, 2024
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
-
This 90-minute webinar is eligible in most states for 1.5 CLE credits.
This CLE course will review this government guidance through the lens of continuing and emerging risk areas seen in case law.
Faculty

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.

Ms. Jacobs focuses her practice in the area of healthcare transactions. Calling upon her years of dedicated experience, she provides practical, pragmatic advice to help her clients achieve their strategic goals. Within the highly regulated health care industry, Ms. Jacobs advises clients, including hospitals, health systems, AMCs and large physician groups, on transactions. She serves as a regulatory adviser, providing fraud and abuse analysis in the context of a deal and ensuring her clients remain compliant with the regulations that govern health care transactions.

Mr. Wade has more than 25 years of experience in the healthcare industry and counsels clients on fraud and abuse issues, fair market value, commercial reasonableness and developing, monitoring, and documenting effective healthcare compliance programs. He serves clients nationally as a compliance professional and assists in negotiating and implementing corporate integrity agreements and in documenting and defending financial arrangements being of fair market value and commercially reasonable between healthcare providers. Mr. Wade has represented healthcare providers, including hospitals, large health systems, and referring physicians in such matters and has also represented healthcare clients under investigation by the U.S. Department of Justice and the Office of Inspector General.
Description
Financial relationships between and among healthcare providers- including both the methods and amounts of compensation--continue to be an area of significant scrutiny and government enforcement activity. With government prosecutors having both civil and criminal enforcement tools in their current toolbox, the stakes can be high. Civil penalties and settlement amounts for actions brought under healthcare fraud and abuse laws have reached tens and even hundreds of millions of dollars, while the government's alternative and complementary use of its criminal enforcement tools has increased. Recent government focus areas include professional services agreements, medical director agreements, management agreements, physician practice support arrangements, employment agreements and ancillary goods and services agreements such as for laboratory services.
In a 2020 memo regarding "Evaluation of Corporate Compliance Programs," the U.S. Department of Justice stated that in its view a well-designed compliance program includes comprehensive due diligence of any transaction targets to identify compensation compliance issues, and that failure to undertake such due diligence can result in significant liabilities. The November 2023 update to OIG’s compliance guidance for healthcare providers contained similar themes.
Listen as our authoritative panel of healthcare attorneys examines the issues in healthcare compensation compliance and the historical and emerging risk areas and related focus areas for due diligence review.
Outline
- New and evolving legal risk areas in compensation and other financial arrangements
- Under the Stark Law
- Under federal Anti-Kickback Statute
- Under federal False Claims Act
- Under federal, state, and local tax exemption laws
- Under federal and state antitrust laws
- Under other select federal and state laws and regulations
- Examples of enforcement activities and resulting liabilities in the evolving risk areas
- The due diligence process: how it may work, what it should do, and how it can shape transactions
- Tips and takeaways for healthcare transactions and compliance programs
Benefits
We will discuss:
- Surprising and recurring themes in the recent government guidance and case law
- An update on new enforcement cases to watch and what might be learned from them
- What a typical compensation compliance due diligence review might entail in 2024
- Methods to mitigate the costs and maximize benefits of due diligence for compensation compliance
- Attorney-client privilege protections and other questions that may come up in due diligence review
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