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As evidenced by a wave of recent cases and settlements, the federal government continues to focus on the federal physician self-referral law (Stark Law) and its implementing regulations. Despite recent enforcement actions, the prohibition on the "taking into account" of designated health services referrals continues to receive far less industry attention than the fair market value or commercial reasonableness standards. Experts Joe Wolfe and Alyssa James will focus on the Stark Law’s volume or value standard, including the underlying regulatory framework, relevant guidance from CMS, and the inherent tensions in the standard as illustrated in recent enforcement actions. Learn the context and direction health care organizations, appraisers, and legal counsel need to know as they navigate this confounding area of health care arrangements.
Program Agenda
Stark Law Overview
Navigating the Volume or Value Standard - Documenting Compliance
Understanding the Volume or Value Standard - Guidance From CMS
Personally Performed Service
The Fair Market Value Standard
The ‘Other Business Generated’ Standard
Compensation Conditioned on Referrals to a Particular Provider
Special Treatment for Stark Group Practices
The Volume or Value Standard - Case Law Illustrations
United States ex. Rel. Villafane v. Solinger - An Objective Test
United States ex rel. Singh v. Bradford Reg’l Med. Ctr. - A Subjective Test
Compensation That Exceeds Professional Collections
Examination of ‘Downstream Data’ and Tracking of Referrals
Practical Takeaways
Learning Objectives
Learn the current regulatory landscape and a better understanding of how to properly develop governance and documentation processes that support compliance with the Stark Law’s volume or value standard.
Gain a better understanding of CMS' guidance on specific matters related to the Stark Law’s volume or value standard.
Get an overview of recent enforcement actions where the government has expressly alleged Stark law violations based on the volume or value standard. The webinar will also review recent enforcement actions regarding compensation that exceeds professional collections and/or a healthcare organization’s examination of downstream referrals. These cases will illustrate the inherent tensions associated with the volume or value standard, such as whether compliance with the standard should be an objective or subjective determination.
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