STARK BASIC TRAINING - The American Health Lawyers Association

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EMPLOYMENT EXCEPTION Required Referrals (411.354(d)(4)) Employer can require employee to refer to a particular provider, practitioner or supplier if: • Referral requirement is in writing, signed • Compensation is set in advance & FMV • Referral requirement not applicable if: • Patient expresses a contrary preference • Provider not covered by patient’s insurance • Not in the patient’s best medical interest … 95 EMPLOYMENT EXCEPTION Required Referrals • <strong>The</strong> required referrals must relate solely to the physician’s services covered by the scope of the employment and be reasonably necessary for the legitimate business purposes of the arrangement Good: Primary Care – Inpatient Bad: Medical Director – Inpatient 96 48
Non-Monetary Compensation Exception (Because sometimes a physician needs a gift basket…) 97 NON-MONETARY COMPENSATION EXCEPTION • Compensation, not including cash or cash equivalents (i.e., gift certificates), up to an aggregate of $373 per year per physician as long as: • Benefit is not determined based upon volume or value of referrals • Benefit is not solicited by physician or anyone affiliated with their practice • Maximum cannot be aggregated to make a larger gift to a group 98 49
Page 1 and 2: STARK BASIC TRAINING Health Care Co
Page 3 and 4: THE SOLUTION: MULTIPLE STATUTES •
Page 5 and 6: WHAT’S NOT PROHIBITED • Physici
Page 7 and 8: THREE QUESTIONS 1. Is there a refer
Page 9 and 10: IMPUTED REFERRALS • Consulting ph
Page 11 and 12: WHAT’S NOT A REFERRAL • Request
Page 13 and 14: DESIGNATED HEALTH SERVICES (Not eve
Page 15 and 16: RESOURCES • 1877(h)(6); 411.351
Page 17 and 18: ENTITY • Multiple DHS entities ca
Page 19 and 20: DIRECT DOCTOR DHS ENTITY (No interv
Page 21 and 22: ICA EXCEPTION • Compensation must
Page 23 and 24: “STAND IN THE SHOES” Physician
Page 25 and 26: RESOURCES • 1877(a)(2), (h)(1)
Page 27 and 28: “SERVICE-BASED” EXCEPTIONS •
Page 29 and 30: FMV RESOURCES • Phase I (pp. 944-
Page 31 and 32: GROUP PRACTICE CRITERIA • Group p
Page 33 and 34: GROUP PRACTICE CRITERIA • Share o
Page 35 and 36: 69 IN-OFFICE ANCILLARY SERVICES EXC
Page 37 and 38: IOAS EXCEPTION Where Are Services P
Page 39 and 40: IOAS EXCEPTION How Are Services Bil
Page 41 and 42: RECRUITMENT • Payments made to in
Page 43 and 44: PSA EXCEPTION • Arrangement is se
Page 45 and 46: RENTAL EXCEPTIONS • Lease is in w
Page 47: EMPLOYMENT EXCEPTION • Employment
Page 51 and 52: NON-MONETARY COMPENSATION EXCEPTION
Page 53 and 54: MEDICAL STAFF INCIDENTAL BENEFITS E
Page 55 and 56: TIPS • Always draw a diagram •

STARK BASIC TRAINING - The American Health Lawyers Association

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