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

This CLE course will guide healthcare counsel on ensuring compliance with the Anti-Kickback Statute (AKS) and Stark law in managed care contracting and downstream provider arrangements. The panel will also provide best practices for counsel on structuring arrangements to fit within the AKS safe harbors and Stark exceptions and the applicable physician incentive plan (PIP) rules.

As providers enter into new payment models, it is important to remember that payment models need to remain compliant with the fraud and abuse laws, including the AKS and Stark laws. The AKS and Stark laws provide several safe harbors and exceptions that shield certain alternative payment arrangements 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 AKS and Stark law requirements and the safe harbors and exceptions when contracting with managed care companies and when structuring downstream 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.