Paying for Referrals: Risky Behavior

Duration: 60 Minutes
The Medicare/Medicaid Fraud and Abuse Anti?Kickback Statute (the "Statute") is alive, still with us and as viable as ever. The Statute provides that the offer or payment, as well as the solicitation or receipt, of "any remuneration" in exchange for referrals of any good, facility, service, or item for which payment may be made in whole or in part under Medicare/Medicaid is prohibited.
Anti-Kickback Statute
Product ID: 500270

The session will provide an overview of the Anti-Kickback Statute (AKS) and review what it prohibits, as well as review the Statute's available safe harbors. It will also show how violation of the AKS can raise FCA concerns, and it will provide an assessment of enforcement activities, showing how participants may be at risk. In addition, the session will review recent cases and show how they potentially impact participants.

We will provide an in-depth review of the AKS, focusing on what is prohibited under the Act and what the exceptions are. We will also review the case law, particularly the early case law that sets the stage and basis for how the courts interpret the law. Since one of the exceptions to enforcement under the Act is regulations promulgated by the Secretary, the "safe harbors," payment practices that will not be subject to criminal prosecution and that will not provide a basis for civil monetary penalties or exclusion from the Medicare or Medicaid programs, we will examine these safe harbors, particularly those more frequently used, to show how protection from enforcement can be achieved. Specifically, we will review the investment, space and equipment rental, personal services/management contracts, and physician recruitment safe harbors.

In addition, we will discuss the OIG's Joint Venture Advisory Opinion, where a hospital expands into a related service line by contracting with an existing provider of that service. The OIG has significant problems with such an arrangement. We will also discuss the recent advisory opinion by the OIG regarding Physician-Owned Entities. OIG views PODs as inherently suspect under the AKS because the opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the AKS.

Finally, the webinar will review various cases to show how easy it is to run afoul of the Statute, and how the courts view compliance with it.

Why Should you Attend:
This program is designed for health care executives, physicians and other health care providers and their managers who participate in and receive remuneration from Medicare, Medicaid, and other federal health care programs such as TriCare. Several recent cases bring home the realization that many activities that are common in other industries are a crime under federal healthcare fraud and abuse laws.

Hospital executives, as well as physicians and/or other health care providers, should be very concerned about the potential for the government to use the Anti-Kickback Statute as one of the prime methods for enforcing the federal fraud and abuse laws. Equally concerning that, along with Stark II (the federal physician anti-referral law), the Anti-Kickback Statute can be and is being used as the basis for an action brought under the Federal False Claims Act. In this webinar, you will learn about the elements of the Anti-Kickback Statute, along with the various exceptions and safe harbors that you can rely on for protection against enforcement under these laws. This is important because under recently enacted health care laws, enforcement and health care fraud task forces have been greatly enhanced. In addition, the Affordable Care Act (better known as Obamacare), the government has greatly enhanced enforcement resources.

Two cases, The Christ Hospital case in Cincinnati, with a settlement in excess of $100 million and the Hardeman Memorial Hospital case in Texas, with a settlement of $398, 230.56 stand out. In addition, in the Hardeman case, the Texas federal court sentenced former CEO Angela Edwards to 2 ½ years in prison and ordered her personally to pay $370,657 in restitution. If that is not enough to get your attention, consider the recent cases finding that the "responsible corporate officer doctrine" allows the government to hold hospital CEOs and others directly responsible for the fraud.

Attend this webinar and learn how to protect yourself and your organization.

Objectives of the Presentation:
To provide the attendee with an understanding of the federal Anti-Kickback Statute and its broad reach, and to give the attendees the tools necessary to protect themselves and their organizations from federal and state enforcement efforts under the Statute.

Who can Benefit:
  • Hospital executives, particularly CEOs, COOs, CFOs, CNOs, and CMOs
  • Nursing home executives
  • Physicians
  • Physician practice managers, and
  • Other healthcare provider executives.
$300
Recorded Session for one participant
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Instructor Profile:
William Mack Copeland, MS, JD, PhD, LFACHE, practices health care law in Cincinnati at the firm of Copeland Law, LLC, where he is the president and the CEO. He is also the president of the Executive & Managerial Development Group, a consulting entity providing compliance and other fraud and abuse related services. A graduate of Northern Kentucky University Salmon P. Chase College of Law, Bill is a frequent author and speaker on health law topics. He is a member of the American Health Lawyers Association, American, Ohio and Cincinnati Bar Associations. A former hospital chief executive officer, he is a life fellow in the American College of Healthcare Executives. He was awarded the American College of Health Care Executives Senior-Level Healthcare Executive Regent's Award in 2007.
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