7/18/2013 - Kameron Gifford, CPC
Could my organization be at risk? What areas exist for potential violations?
Anti Kickback Enforcement -
In the past, kickback enforcement actions have concentrated
on three areas: kickbacks related to costs shown on cost re-ports; physician
referrals to hospitals, suppliers, and ancillary services; and hospital
referrals to entities that provide services to patients after hospitalization,
such as medical equipment suppliers or nursing services. However, there is an
increasing role in healthcare for payors and middlemen who control or influence
purchasing decisions by using access to patient health and utilization information
and provider data. These payors and middlemen may pay kickbacks to obtain or
retain contracts, to receive favorable treatment in contracts, to obtain confidential
patient or provider data, or to influence agents or fiduciaries to exercise discretion
on behalf of a principal in favor of the payor. This body of law can be complex
because the techniques used by payors and recipients vary by industry, and
there are more extensive and complicated money flows among the parties and related
Stark Act Definitions.
Who is part of my immediate family?
What counts as a financial relationship?
What is an Ownership or Investment Interest? What counts as an Indirect Ownership or Investment Interest?
An ownership or investment interest in a DHS entity can take the form of equity, debt, stock, certain stock options, partnership interests, memberships interests in an LLC, etc. An ownership or investment interest “includes an interest in an entity that holds an ownership or investment interest” in the DHS entity. Thus, an ownership interest in a subsidiary company is not an ownership interest in the parent or another subsidiary of the parent unless the subsidiary has an interest in the parent or another subsidiary of the parent. An interest in a retirement plan is specifically excluded from the definition of ownership or investment interest. The following, while specifically excluded from the definition of ownership or investment interest, are
nonetheless considered a form of “compensation arrangement”:
1) stock options or convertible securities until executed;
2) an “under arrangement” contract between a hospital and a physician-owned entity;
3) a security interest held by a physician in equipment sold to a hospital and financed
through a loan from the physician; and
4) an unsecured loan subordinated to a credit facility.
What is a Compensation Arrangement? What counts as an Indirect Compensation Arrangement?
Concerned your Financial Relationships Might Implicate the Stark Act?
What is the Anti-Kickback Law and How is it Different from Stark?
“Safe Harbor” Transactions