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Structuring Physician Incentives: Regulatory Compliance, Avoiding Potential Pitfalls
Fair Market Value, Commercial Reasonableness, and Volume/Value of Referrals Considerations
Welcome to BARBRI, the trusted global leader in legal education. Continue to access the same expert-led Strafford CLE and CPE webinars you know and value. Plus, explore professional skills courses and more.
About the Course
Introduction
This CLE course 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 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.
Presented By
Ms. Ferrari is a nationally recognized expert on fair market value and commercial reasonableness, the "Big Three" and their role in regulatory compliance, investigations, and litigation. She has authored over 100 publications and presentations on topics related to physician and healthcare provider compensation, contracting, investigations, and related ethical issues. She is known for her work with rural, academic, public, and clinically integrated, value-based healthcare systems. Ms. Ferrari's focus areas include compensation review for compliance with fraud and abuse laws, tax-exempt regulations, antitrust laws, anti-discrimination laws, and assisting clients in transition to value-based payments, including structuring participation agreements, compensation plans and incentive payments in the context of coordinated care and provider alignment strategies, such as clinically integrated networks, ACOs, gainsharing and "Hospital Quality and Efficiency Programs." Prior to joining Hancock Daniel, she was Principal and GC for a national advisory and healthcare solutions firm and a Partner at a well-known national compensation consulting and advisory firm, where she led the service line focused on CINs, ACOs, and other value-based care structures and worked with clinically integrated network and ACO participants across the U.S.
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.
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
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Live Online
On Demand
Date + Time
- event
Monday, December 9, 2024
- schedule
1:00 p.m. ET./10:00 a.m. PT
- Comparison of typical physician incentive arrangements historically vs. in the current environment
- The current and evolving regulatory environment and the dangers in improperly structured incentive arrangements in this environment, including:
- New (and unchanged) standards of what is FMV, commercially reasonable, and/or improperly based on volume or value of referrals
- 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
- Observations and best practices for avoiding pitfalls in the design and structuring of incentive arrangements
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?
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