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Structuring Physician Incentives: Regulatory Compliance, Avoiding Potential Pitfalls
Fair Market Value, Commercial Reasonableness, and Volume/Value of Referrals Considerations
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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 member of Hancock Daniel’s corporate healthcare group, where she focuses on issues related to transactional and enterprise compensation planning, governance and review, particularly issues related to fair market value and commercial reasonableness. Although her past experience encompasses a multitude of regulatory, transactional, governance and investigation matters, Ms. Ferrari is known especially for her work in recruitment and retention of highly compensated thought leader physicians and executives; and incentive payment distributions through ACOs and clinically integrated networks to advance value-based care initiatives. She has worked extensively with clients navigating the intersection of regulatory and financial considerations in clinical research, including agreements for funding and support services and the related issues of contracting and compliance; transactional due diligence for compensation compliance; and navigating the intersection of compensation and antitrust issues. Ms. Ferrari's expertise also includes recruitment, compensation and procurement governance for “essential” hospitals such as public, rural, academic and pediatric hospitals.
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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