Corporate Integrity Agreement Highlights Individual Accountability within Health Care Organizations

A physician-owned chain of family medicine clinics located in and around Columbia, South Carolina, Family Medicine Centers of South Carolina, LLC (“FMC”), has agreed to pay the United States $1.56 million, and its principal owner and former chief executive officer, Dr. Stephen F. Serbin, and its former Laboratory Director, Victoria Serbin, have agreed to pay $443,000, to resolve a False [...]

By |2017-11-08T10:10:41-07:00October 13, 2017|

CMS Updates Self-Referral Disclosure Protocol

The Centers for Medicare and Medicaid Services recently updated the Self-Referral Disclosure Protocol (SRDP), seeking to revise the currently approved information collection request that advises hospitals on how to disclose an actual or potential violation of the physician self-referral statute. As an additional update, CMS is also issuing a required form for SRDP submissions. CMS is seeking to revise the [...]

By |2016-12-27T11:06:24-07:00June 7, 2016|

CMS Updates Stark Law to Improve Health Care Delivery

The Center for Medicare and Medicaid Services (CMS) issued a Final Rule [80 Federal Register 70886, 71300] making changes to the Physician Self-Referral Law (i.e. “Stark Law”) on Oct. 30. The Final Rule, which was published in the November 16, 2015 Federal Register, represents the first major updates to the Stark Law since 2009. Most of the provisions in the [...]

By |2016-12-27T11:06:28-07:00January 7, 2016|

Maintaining Compliance When Entering Into Physician Professional Service Agreements

Professional Service Agreements (PSAs) are an increasingly popular mode of collaboration between physicians and hospitals, and for good reason. PSA establish the terms on which a physician or physician group will provide services to a hospital or health care facility on an independent contractor basis.  Thus, these arrangements offer an alternative to direct employment of physicians by a hospital.  From [...]

By |2016-12-27T11:06:28-07:00January 5, 2016|

Greg Lindquist presents to Association of Health Care Auditors and Educators

BOULDER—Aug. 4, 2015—Caplan and Earnest health care law attorney Gregory Lindquist was selected to present to the Association of Health Care Auditors and Educators on Aug. 7 in Denver at the association’s annual national conference. Titled “Auditor Dilemmas, Obligation and Liability,” the presentation will cover a number of legal and regulator issues related to health care charts, billing and coding. [...]

By |2016-12-27T11:06:36-07:00August 4, 2015|

CMS Publishes Proposed Rule with Modifications to Stark Law

The Centers for Medicare and Medicaid Services recently published the 2016 Physician Fee Schedule, which notably included several proposed modifications to the Stark Law, or Physician Self-Referral Statute. The Stark Law prohibits physicians from making referrals for designated health services (DHS) payable by Medicare to entities in which the physician has a financial interest, unless the financial relationship meets an [...]

By |2016-12-27T11:06:36-07:00July 29, 2015|

Tuomey Healthcare Systems Hit with $237 Million Judgment for Stark Law Violations

Earlier this month, nonprofit hospital Tuomey Healthcare Systems, which serves an underserved rural South Carolina community, was handed a “likely death sentence” judgment of $237 million owed for Stark Law violations. The Fourth Circuit Court of Appeals affirmed the decision, which may have unsettling ramifications for physician compensation for all hospitals. In the original case appealed in United States Drakeford [...]

By |2016-12-27T11:06:37-07:00July 14, 2015|

Physician Compensation Under a Spotlight with Regulatory Agencies

Hospitals that pay physicians generously even though their practices are losing money may be opening themselves to fraud and abuse claims under the Stark law, which says health care organizations must value this compensation as “commercially reasonable.” The practice of overpaying physicians sometimes occurs after a physician practice has been purchased by the health care organization. While the practices might [...]

By |2016-12-27T11:06:37-07:00June 16, 2015|

Hospital Embezzlement Scheme Highlights Critical Nature of Compliance Programs

An embezzlement scheme at a Houston-area hospital—a fraud that cost the hospital system more than $9 million over 14 years—was uncovered when an anonymous tip was issued to the compliance officer. Recognizing the severity of the matter, the officer quickly investigated, leading to charges and an arrest of a long-time manager. The embezzlement involved the manager sending himself “ghost” invoices, [...]

By |2016-12-27T11:06:40-07:00April 6, 2015|