Paying for Referrals: A Danger to Your Freedom + Best Practices for Physician Auditing – Combo

Paying for Referrals: A Danger to Your Freedom

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.

Who Can Benefit

• Hospital executives, particularly CEOs, COOs, CFOs, CNOs, and CMOs;
• Nursing home executives;
• Physicians;
• Physician practice managers; and
• Other healthcare provider executives.

Target Audience

• Hospital executives, particularly CEOs, COOs, CFOs, CNOs, and CMOs;
• Nursing home executives;
• Physicians;
• Physician practice managers; and
• Other healthcare provider executives.

Background

The AKS is currently the focus of law enforcement officials. 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.
Recent cases and/or enforcement actions involving the AKS, violation of which has been held to be the basis of an action under the Federal False Claims Act, (“FCA”) raise serious concerns regarding compliance issues with hospital, physician practices and other healthcare entities. Recoveries under the FCA are at an all-time high, and the percentage of actions involving healthcare organizations has been increasing at exponential rates.

Areas Covered in this Presentation

• Federal Civil Anti-Kickback Statute,
• Safe Harbors providing protection under the AKS,
• Enforcement activities involving the AKS,
• The OIG’s Joint Venture Advisory Opinion,
• The OIG’s advisory opinion regarding Physician-Owned Entities, and
• The anti-fraud provisions of the Affordable Care Act.

Best Practices for Physician Auditing

Is your practice audit safe? Do you have compliance risks? The first issue will be where do you start to determine your risk. Some key questions to ask: Is this a compliance or educational audit? Is this a baseline audit or a more focused audit? Do you have an internal audit team or do you need to hire external auditors? The type of audit will determine where to start, how many services to review and the type of service(s) to be audited. Is there a time limitation? Has there been a previous audit that showed issues that need attention? Have there been internal or external complaints that need to be reviewed? This webinar will discuss best practices and all of these issues as well as how to determine a pull and how many services should be included in the audit.

Webinar Objectives

• How to determine the scope/sample of the audit
• Government suggestions for auditing.
• The difference between a concurrent versus retrospective audit.
• What is the difference in an educational audit and a compliance audit
• What is an attorney client privilege audit.
• How does the type of practice change the audit focus.
• What are the risk areas depending on the type of physician practice.

Webinar Highlights

• Auditing for office services
• Incomplete documentation for office ancillary services such as injections, cerumen impaction removal, nebulizer treatments etc
• “Incident to”
• Initial, subsequent hospital and observation services.
  • Shared care
• Auditing for surgical and specialty practices
• Modifier usage

Who Should Attend

• Office managers
• Compliance team and officers
• Coders
• Providers
• Denial management staff