Reducing Patient Leakage by Directing Physician Referrals, AKS Safe Harbors, and Stark Law Exceptions
Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
- work Practice Area
Health
- event Date
Wednesday, October 27, 2021
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
This CLE course will guide healthcare counsel on combatting patient leakage. The panel will discuss whether and how healthcare systems are currently using directed referral requirements. The panel will also address how to implement referral requirements in compliance with the Stark Law. The panel will offer best practices for healthcare systems interested in using, monitoring, and enforcing directed referral requirements. The panel will also address safe harbors to the AKS and exceptions to the Stark Law to incentivize physicians to achieve health outcomes.
Ms. Lovitch counsels clients on regulatory, transactional, and operational issues, including Medicare coverage and reimbursement, the development and implementation of health care compliance programs, and licensure and certification matters. In addition, she advises clients on the legal, practical, and fraud and abuse implications of business arrangements.
Ms. Yount’s practice involves a variety of regulatory, compliance, and transactional matters for a broad range clients across the healthcare industry, including healthcare systems, managed care organizations, pharmacies, device and pharmaceutical manufacturers, long-term and post-acute care providers, and private equity firms investing in the health care industry. She is particularly well versed in the federal anti-kickback statute, the Stark Law, state fraud and abuse laws, beneficiary inducement prohibitions, provider-based rules, Medicare and Medicaid program requirements, and the federal Physician Payments Sunshine Act. Ms. Yount regularly advises clients on the regulatory framework for value-based healthcare, including new and evolving CMS-sponsored payment models (e.g., ACO REACH, Medicare Shared Savings Program, Kidney Care Choices). She is particularly adept at assisting healthcare companies in navigating the anti-kickback statute safe harbors and Stark Law exceptions for value-based care. Ms. Yount is frequently invited to speak on healthcare fraud and abuse, compliance, and other health law matters.
Many healthcare systems are experiencing patient leakage when patients choose out-of-network providers over those in network. As a result, the healthcare systems are losing substantial revenue. This often occurs because physicians refer patients for out-the-network services.
Many hospitals or healthcare systems do not include provisions in their physician contracts that would require that the physicians only refer their patients for in-network services (directed referral requirements). This is often because the hospitals or healthcare systems are concerned about Stark violations or that such requirements would (or would appear to) interfere with the doctors' medical judgment.
Hospital and healthcare system leadership and counsel need to understand when and how to use directed referral requirements to combat patient leakage and the value-based safe harbors to the federal and state anti-kickback statutes and exceptions to the Stark Law to incentivize physicians to achieve health outcomes for a patient population.
Listen as our authoritative panel of healthcare attorneys examines whether and how healthcare systems currently use directed referral requirements. The panel will also address how directed referral requirements can be implemented in compliance with the Stark Law. The panel will offer best practices for healthcare systems interested in using, monitoring, and enforcing directed referral requirements. The panel will also address safe harbors to the AKS and exceptions to the Stark Law to incentivize physicians to achieve health outcomes.
- Directed referral requirements
- Whether and how to use
- Implementation in compliance with healthcare regulations
- Best practices
- Using directed referral requirements
- Monitoring directed referral requirements
- Enforcing directed referral requirements
- AKS safe harbors and Stark exceptions
The panel will review these and other key issues:
- How can healthcare systems use directed referral requirements to minimize patient leakage?
- How can directed referral requirements be implemented in compliance with the Stark Law?
- What best practices should hospitals and healthcare systems employ to monitor and enforce directed referral requirements?
