Fair Market Value, Commercial Reasonableness, and Volume/Value of Referrals Considerations

A live 90-minute CLE webinar with interactive Q&A featuring HealthCare Appraisers’ Andrea M. Ferrari, JD, MPH.

Tuesday, June 2, 2020

1:00pm-2:30pm EDT, 10:00am-11:30am PDT 

This CLE webinar will guide healthcare counsel on physician incentives, examining the legal requirements and the potential risks. The panel will compare current incentives and value-based incentives and discuss the impact on regulatory compliance. The panel will offer best practices for structuring physician incentives.

Description

The healthcare industry is steadily shifting from reimbursement based on the volume of services to the value of care provided. To keep pace with this shift, provider contracts and transactions increasingly include financial incentives to encourage coordinated efforts toward improvement on measures of value in care delivery. Although these types of financial incentives are reasonable and even necessary to achieve the needed changes in provider practices and behaviors, they are fraught with potential regulatory pitfalls.

Several recent federal False Claims Act cases illustrate that providers must carefully consider incentives in the context of facts and circumstances. If not, providers may face legal troubles, particularly with the rules for ensuring that financial arrangements are fair market value (FMV), commercially reasonable, and not improperly based on volume or value of referrals.

Listen as our authoritative panel of healthcare legal advisers discusses emerging trends in financial incentives for physicians and other providers and the pitfalls in properly documenting, structuring, and implementing them.

Outline

I. Comparison of typical physician incentive arrangements historically vs. in the current environment
II. The current and evolving regulatory environment and the dangers in improperly structured incentive arrangements in this environment, including:

A. New (and unchanged) standards of what is FMV, commercially reasonable, and/or improperly based on volume or value of referrals; and
B. Recent regulatory enforcement actions and court cases that are illustrative of the pitfalls of certain newer types of incentives, including those that on their face may seem reasonable

III. Observations and best practices for avoiding pitfalls in the design and structuring of incentive arrangements

Benefits

The panel will review these and other key issues:

  • What steps can healthcare advisers take to ensure regulatory compliance when structuring physician incentives?
  • What are the implications for compliance with the Stark Law, the AKS, and other laws and regulations?
  • What lessons can healthcare counsel take away from recent enforcement actions?

Register today, or learn more, by visiting the Stafford website here.