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In October, the Centers for Medicare and Medicaid Services (CMS) released its newly proposed updates to the Stark regulations that included an overhaul of the definition of fair market value (FMV) for regulatory compliance purposes. Surprisingly, CMS pointed to a whole new framework for FMV and valuation practice in general. To help practitioners prepare for the new paradigm, Tim Smith will do a deep dive into the proposed redefinition of FMV and how CMS now proposes to view valuation under the Stark law. It will examine CMS’ new definition in light of the valuation body of knowledge across the four major valuation disciplines, including business, compensation, M&E, and real estate valuation. Learn to identify missteps and positive steps in the proposed regulations, highlighting the apparent paradigm shift in the government’s thinking on standard valuation practice for regulatory compliance purposes.
Program Agenda
The Actual and the Hypothetical in FMV Based on Valuation Theory
The hypothetical willing buyer and seller based on actual market conditions
Valuing an actual transaction in healthcare regulatory compliance work
Valuing an actual subject, not a hypothetical one
Using the actual facts and circumstances
The Buyer and Seller in Healthcare Transactions
Markets with multiple buyer types
Markets with predominant or single buyer types
Unique market conditions
How the regulatory purpose/use prevents certain characteristics of the hypothetical buyer and seller from being used
Overview of FMV and Valuation Practice under Current Healthcare Regulations
Stark law and regulations
Anti-kickback statute
Tax-exempt regulations
The Proposed Redefinition of FMV
The government’s view of FMV as a “hypothetical value” of a “hypothetical transaction”
“Market value” as the new basis for general market value under Stark
What is “market value”?
“Market value” as investment value
The problems with the new definition of FMV and general market value
The New Move Towards “General Concepts and Principles in the Valuation Community”
CMS’ affirms standard valuation practice?
What are “accepted market valuation principles”?
A Critical Analysis of CMS’ Compensation Examples
The “rock star” orthopedic surgeon
The family physician and the reluctant hospital
How “survey says” is the root problem in CMS’ compensation examples
How accepted valuation principles would approach the examples
A paradigm shift away from “survey says”?
Learning Objectives
List the differences between the actual and the hypothetical in FMV based on the valuation body of knowledge
Contrast the historical perspective of healthcare regulators on matters of FMV and valuation
Examine the changes in the proposed redefinition of FMV for the Stark regulations
Explain how to prepare for future valuation work under the new paradigm for FMV and accepted valuation practice
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