March 13, 2024
Stark Integrity Podcast: Documentation in Physician Financial Arrangements, DOJ FCA Settlements, Commercial Reasonableness and FMV, Substance Abuse, and New Stark Law Episodes
Check out the latest episode on the Stark Integrity podcast hosted by Nelson Mullins Riley & Scarborough LLP's Nashville partner Bob Wade, featuring professionals in the healthcare industry including Tim Smith, Principal at TS Healthcare Consulting.
Fair Market Value under New Stark Law Regulations: A Discussion with Tim Smith from TS Healthcare Consulting
Commercial Reasonableness (CR) is like a pie. Fair Market Value (FMV) is like a slice of the pie. In this episode, Wade discusses the latest on FMV under the Stark Law with Tim Smith. Hear why you need to study the regs, start doing economic analysis, start developing in-house expertise in this area, what you need to say loudly and clearly, and insights from Tim’s book, “The Complete Guide to Fair Market Value Under the Stark Regulations.”
Stark Law and Substance Abuse and Addiction
Under the Stark Law, entities with medical staffs can pay for treatment and promotion of mental health. In this episode, Wade dives into the tough topics of substance abuse and addiction as they relate to the Stark Law. Hear why we’re all addicted to something, the new exception under the Stark Law, why the exception is a good thing, the 5 characteristics of an addiction, and which medical profession has the highest burnout rate.
The Connection (and Disconnect) between Commercial Reasonableness and Fair Market Value
FMV and CR are separate concepts, but overlap. In this episode, Wade talks all things FMV vs. CR. Hear why CR is not one of value, it has 2 components, where the overlaps exist, Wade’s pie analogy, and what factors to consider.
DOJ 2023 Fiscal Year False Claims Act Settlements
The Department of Justice (DOJ) collected $2.68 billion under the False Claims Act (FCA) in Fiscal Year 2023. In this episode, Wade recaps the latest interesting stats from FCA settlements. Hear why the FCA is still a very vital weapon for the government to pursue fraud, how healthcare made up 67% of the FCA settlements in Fiscal Year 2023, qui tam relators brought 86% of settlements, other record-setting numbers from the year, and a nod to Carl Sagan’s Billions & Billions.
Importance of Documentation in Physician Financial Arrangements
Make sure documentation related to physician financial arrangements helps you, not hurts you. In this episode, Wade shares how this documentation can work to your advantage. Hear why training is critical, why you should look at your documentation through the eyes of the DOJ, Officer of Inspector General (OIG), or a qui tam relator, how to do periodic audits or reviews, who to include on emails, and how to know the waters of the negotiating pool.
