The SUPPORT Act takes sweeping aim at the opioid crisis, focusing on numerous aspects of opioid prevention, treatment, and recovery and expanding various types of coverage, use of telemedicine, and electronic prescribing, among other things.
This webinar will highlight important parts of the new law as it pertains to SUD treatment providers and how the law will potentially impact profitability and treatment offerings.
Presented by Harry Nelson – Founder & Managing Partner, Nelson Hardiman; Chairman, Behavioral Health Association of Providers - and Paul D. Gilbert – Member of the Firm, Epstein Becker Green.
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/unpacking-the-support-for-patients-and-communities-act-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
How the Opioid Crisis and the SUPPORT Act Created a New Enforcement Reality: ...Epstein Becker Green
How the Opioid Crisis and the SUPPORT Act Created a New Enforcement Reality: Trends in Behavioral Health Webinar Series
Presented by
Richard W. Westling – Member, Epstein Becker Green
Katherine Bowles – Attorney, Nelson Hardiman
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
During 2018, the Department of Justice dedicated additional enforcement resources to address the opioid crisis. By adding criminal penalties targeted at kickbacks in the SUD provider space, the SUPPORT Act significantly enhanced the many tools already available to the DOJ. These efforts will also likely further embolden private payor review activities.
More info: https://www.ebglaw.com/events/how-the-opioid-crisis-and-the-support-act-created-a-new-enforcement-reality-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Marketing Best Practices in Light of the SUPPORT for Patients and Communities...Epstein Becker Green
Presented by Kathryn F. Edgerton (Partner, Nelson Hardiman) and Anjali N.C. Downs (Member, Epstein Becker Green).
While the industry has long recognized the harm and abuse that results from “body brokering” and the improper use of “sober homes,” the SUPPORT for Patients and Communities Act criminalizes deceptive and misleading marketing practices that may still be used by some SUD providers.
This webinar will discuss the current state of SUD-related marketing activities and will equip well-intentioned SUD providers with the resources to recognize marketing pitfalls, including activities that are now illegal. Your reputation as a provider is an essential asset, and this webinar will help you understand how to effectively market without placing your organization in legal jeopardy.
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/marketing-best-practices-in-light-of-the-support-for-patients-and-communities-act-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Healthcare fraud is costing the United States tens of billions of dollars a year and according to William Rudman of AHIMA foundation, the most frightening fact is that the major chunk of fraud happens under the radar and majority of the frauds are left unnoticed; besides that, those of frauds which are identified are not brought into litigation for many years together. Financial fraud and false claims are the most common types of healthcare fraud, according to the AHIMA Foundation report, this includes false claims for medically unnecessary services; false claims that include purposeful overstatement of the amount, number, type, or complexity of the service provided; or false claims that include services that were never rendered or were not rendered on the individuals claimed or by the provider claimed. Another issue associated with fraud and abuse are when physicians refer patients out of financial interest rather than curing the patients. This short presentation is intended to give an overview on two major statutes that help to fight against a variety of fraud, The False Claim Act & Stark Law.
How the Opioid Crisis and the SUPPORT Act Created a New Enforcement Reality: ...Epstein Becker Green
How the Opioid Crisis and the SUPPORT Act Created a New Enforcement Reality: Trends in Behavioral Health Webinar Series
Presented by
Richard W. Westling – Member, Epstein Becker Green
Katherine Bowles – Attorney, Nelson Hardiman
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
During 2018, the Department of Justice dedicated additional enforcement resources to address the opioid crisis. By adding criminal penalties targeted at kickbacks in the SUD provider space, the SUPPORT Act significantly enhanced the many tools already available to the DOJ. These efforts will also likely further embolden private payor review activities.
More info: https://www.ebglaw.com/events/how-the-opioid-crisis-and-the-support-act-created-a-new-enforcement-reality-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Marketing Best Practices in Light of the SUPPORT for Patients and Communities...Epstein Becker Green
Presented by Kathryn F. Edgerton (Partner, Nelson Hardiman) and Anjali N.C. Downs (Member, Epstein Becker Green).
While the industry has long recognized the harm and abuse that results from “body brokering” and the improper use of “sober homes,” the SUPPORT for Patients and Communities Act criminalizes deceptive and misleading marketing practices that may still be used by some SUD providers.
This webinar will discuss the current state of SUD-related marketing activities and will equip well-intentioned SUD providers with the resources to recognize marketing pitfalls, including activities that are now illegal. Your reputation as a provider is an essential asset, and this webinar will help you understand how to effectively market without placing your organization in legal jeopardy.
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/marketing-best-practices-in-light-of-the-support-for-patients-and-communities-act-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Healthcare fraud is costing the United States tens of billions of dollars a year and according to William Rudman of AHIMA foundation, the most frightening fact is that the major chunk of fraud happens under the radar and majority of the frauds are left unnoticed; besides that, those of frauds which are identified are not brought into litigation for many years together. Financial fraud and false claims are the most common types of healthcare fraud, according to the AHIMA Foundation report, this includes false claims for medically unnecessary services; false claims that include purposeful overstatement of the amount, number, type, or complexity of the service provided; or false claims that include services that were never rendered or were not rendered on the individuals claimed or by the provider claimed. Another issue associated with fraud and abuse are when physicians refer patients out of financial interest rather than curing the patients. This short presentation is intended to give an overview on two major statutes that help to fight against a variety of fraud, The False Claim Act & Stark Law.
Commercial Payor Behavioral Health Audits: How to Avoid Getting Wiped OutEpstein Becker Green
The number of commercial payor audits of behavioral health facilities has been steadily rising, forcing closures of multiple treatment facilities, straining resources, and setting up an increasingly contentious conflict between treatment providers and payors.
This webinar will examine the most common issues arising in payor audits (including medical necessity; patient financial responsibility; and other issues asserted to constitute fraud, waste, or abuse) and the common arguments used as grounds for the nonpayment or recoupment of fees by insurers. The presenters will also review responsive strategies in commercial payor audits and examine defensive strategies and best practices to avoid fraud, waste, and abuse.
Presented by:
Paul D. Gilbert – Member, Epstein Becker Green
John A. Mills – Partner, Nelson Hardiman
Part of a "first Thursdays" fall webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/how-to-avoid-getting-wiped-out-by-the-wave-of-commercial-payor-behavioral-health-audits-medical-necessity-and-waivers-of-co-insurance-and-deductibles/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Buried somewhere in the longest piece of legislation ever is the No Surprises Act. Signed into law on December 27, 2020, it expands restrictions on charging out-of-network rates for certain services. Discover what it means for your business: https://bit.ly/3cfmHg4
Coordination of Benefits and its implications to Health PlansCitiusTech
Coordination of Benefits (COB) allows plans that provide health and/or prescription coverage with Medicare to determine their respective payment responsibilities (i.e. determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan). Member’s primary plan has the responsibility of paying claims first, followed by coverage by remaining plans. This process of splitting the costs across multiple coverage is called COB. This document introduces COB and how health plans and members benefit through COB regulations.
Getting the deal through life sciences russia 2015Lidings Law Firm
Produced annually by UK publishers Law Business Research Ltd., this 2015 edition of Getting the Deal Through: Life Sciences has been fully revised and updated to cover the key issues of current applicable regulation, including full analysis of important aspects of cross-border transactions and international law. With contributions from leading practitioners active in 26 jurisdictions worldwide, Lidings’ attorneys have authored exclusive coverage of Russian regulation of the life sciences sector, including those issues of most direct relevance to the firm’s major pharmaceutical clients.
Common challenges faced by Physicians and Practitioners with Medical Billingjennyvergeese
Medical billing refers to the process of filing and following up on claims with health insurance companies / providers in order to receive payments for the healthcare services rendered to patients by the practices / physicians. Medical billing serves as an effective channel between medical service providers and insurance companies.
Auditing Healthcare Focus Arrangements for Regulatory CompliancePYA, P.C.
PYA Principal Tynan Kugler and Consulting Manager Susan Thomas presented “Auditing Healthcare Focus Arrangements for Regulatory Compliance: Physicians, Management Services, Post-Discharge Care, Ambulance Services, and Specialty Care.” Their presentation:
- Describes what constitutes a focus arrangement for healthcare organizations.
- Explains the implications of Stark Law and Anti-Kickback violations, along with Corporate Integrity Agreement focus arrangement requirements.
- Discusses essential focus arrangement procedures to facilitate regulatory compliance.
- Provides an example design of an audit plan approach for focus arrangements.
Health Care Reform - list of items for employers as we approach 2013 and 2014. Join us 9/12/12 for our event on the Affordable Care Act/Health Care Reform.
Forensic and Valuation Issues in HealthcarePYA, P.C.
PYA Principal Carol Carden co-presented “Forensic and Valuation Issues in Healthcare” at the AICPA Forensic & Valuation Services Conference in New Orleans, LA, November 10, 2014.
Best Practices in Physician Arrangements: Combat Contract Compliance ConcernsPYA, P.C.
OIG This presentation highlights the importance of regulatory requirements and the consequences of non-compliance for healthcare organizations that deal with physician arrangements.
Addresses regulatory considerations such as the Stark Law, Anti-Kickback Statute, and False Claims Act.
Explores additional risk areas such as OIG Fraud Alerts, Medicare Cost Report Certification, and the responsibilities of boards of directors.
Commercial Payor Behavioral Health Audits: How to Avoid Getting Wiped OutEpstein Becker Green
The number of commercial payor audits of behavioral health facilities has been steadily rising, forcing closures of multiple treatment facilities, straining resources, and setting up an increasingly contentious conflict between treatment providers and payors.
This webinar will examine the most common issues arising in payor audits (including medical necessity; patient financial responsibility; and other issues asserted to constitute fraud, waste, or abuse) and the common arguments used as grounds for the nonpayment or recoupment of fees by insurers. The presenters will also review responsive strategies in commercial payor audits and examine defensive strategies and best practices to avoid fraud, waste, and abuse.
Presented by:
Paul D. Gilbert – Member, Epstein Becker Green
John A. Mills – Partner, Nelson Hardiman
Part of a "first Thursdays" fall webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/how-to-avoid-getting-wiped-out-by-the-wave-of-commercial-payor-behavioral-health-audits-medical-necessity-and-waivers-of-co-insurance-and-deductibles/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Buried somewhere in the longest piece of legislation ever is the No Surprises Act. Signed into law on December 27, 2020, it expands restrictions on charging out-of-network rates for certain services. Discover what it means for your business: https://bit.ly/3cfmHg4
Coordination of Benefits and its implications to Health PlansCitiusTech
Coordination of Benefits (COB) allows plans that provide health and/or prescription coverage with Medicare to determine their respective payment responsibilities (i.e. determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan). Member’s primary plan has the responsibility of paying claims first, followed by coverage by remaining plans. This process of splitting the costs across multiple coverage is called COB. This document introduces COB and how health plans and members benefit through COB regulations.
Getting the deal through life sciences russia 2015Lidings Law Firm
Produced annually by UK publishers Law Business Research Ltd., this 2015 edition of Getting the Deal Through: Life Sciences has been fully revised and updated to cover the key issues of current applicable regulation, including full analysis of important aspects of cross-border transactions and international law. With contributions from leading practitioners active in 26 jurisdictions worldwide, Lidings’ attorneys have authored exclusive coverage of Russian regulation of the life sciences sector, including those issues of most direct relevance to the firm’s major pharmaceutical clients.
Common challenges faced by Physicians and Practitioners with Medical Billingjennyvergeese
Medical billing refers to the process of filing and following up on claims with health insurance companies / providers in order to receive payments for the healthcare services rendered to patients by the practices / physicians. Medical billing serves as an effective channel between medical service providers and insurance companies.
Auditing Healthcare Focus Arrangements for Regulatory CompliancePYA, P.C.
PYA Principal Tynan Kugler and Consulting Manager Susan Thomas presented “Auditing Healthcare Focus Arrangements for Regulatory Compliance: Physicians, Management Services, Post-Discharge Care, Ambulance Services, and Specialty Care.” Their presentation:
- Describes what constitutes a focus arrangement for healthcare organizations.
- Explains the implications of Stark Law and Anti-Kickback violations, along with Corporate Integrity Agreement focus arrangement requirements.
- Discusses essential focus arrangement procedures to facilitate regulatory compliance.
- Provides an example design of an audit plan approach for focus arrangements.
Health Care Reform - list of items for employers as we approach 2013 and 2014. Join us 9/12/12 for our event on the Affordable Care Act/Health Care Reform.
Forensic and Valuation Issues in HealthcarePYA, P.C.
PYA Principal Carol Carden co-presented “Forensic and Valuation Issues in Healthcare” at the AICPA Forensic & Valuation Services Conference in New Orleans, LA, November 10, 2014.
Best Practices in Physician Arrangements: Combat Contract Compliance ConcernsPYA, P.C.
OIG This presentation highlights the importance of regulatory requirements and the consequences of non-compliance for healthcare organizations that deal with physician arrangements.
Addresses regulatory considerations such as the Stark Law, Anti-Kickback Statute, and False Claims Act.
Explores additional risk areas such as OIG Fraud Alerts, Medicare Cost Report Certification, and the responsibilities of boards of directors.
7 Signs Your Organization Could Have Risky ContractsMD Ranger, Inc.
In this webinar, we will talk about how to spot potentially risky situations and contracts at your organization. Join Allison Pullins, Chief Marketing Officer at MD Ranger, Inc, for this 30-minute webinar as she discusses:
-Red flags pointing to a compliance problem
-Strategic physician contracting practices
-Safeguarding against legal and compliance risks
-...and more!
US Medical Billing A Comprehensive Overview for Healthcare Providers.pdfmedquikhelathsolutio
The intricate world of medical billing can feel like a labyrinth for healthcare providers. Between deciphering complex medical codes, navigating insurance regulations, and ensuring timely reimbursements, it's easy to get overwhelmed.
Chapter 2Fraud and Abuse StarkPhysician Self-Referral and EstelaJeffery653
Chapter 2
Fraud and Abuse: Stark/Physician Self-Referral and Anti-Kickback
Learning Objectives
Physician Self-Referral (Stark) Law and Anti-Kickback Statute (AKS)
Services, individuals, organizations, and transactions affected by these laws.
Specific behaviors prohibited.
Exceptions and “safe harbors” for avoiding liability.
Anticipating and preventing violations.
Physician Self-Referral Law (Stark)
Initial law (Stark I) sponsored by Congressman Pete Stark enacted in 1989 and applied only to clinical laboratory services.
Omnibus Budget Reconciliation Act of 1993 (Stark II) expanded law to additional 10 types of clinical services.
Patient Protection and Affordable Care Act of 2010 added restrictions on physician-owned hospitals and required the issuance of a self-referral disclosure protocol.
Stark Prohibition
“... If a physician (or an immediate family member of such physician) has a financial relationship with an entity ..., then the physician may not make a referral to the entity for the furnishing of designated health services for which payment otherwise may be made” under Medicare (also applicable to Medicaid). (underlining added).
“Physician”
The person making the referral may be a(n)
MD
Osteopath
Dentist
Podiatrist
Optometrist, or
Chiropractor
“Immediate family member”
Besides the referring physician herself, this person may be a
spouse;
parent, child, or sibling (by birth or adoption);
stepparent, stepchild, step-brother, or step-sister;
father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law;
grandparent or grandchild; or
spouse of a grandparent or grandchild.
“Entity”
The entity with which there is a financial relationship must be one that bills CMS for designated health services (DHS) or that furnishes all or most of the components of the DHS.
This includes the person or entity that actually performs the DHS, or presents a claim for DHS services to the Medicare program.
7
“Financial relationship”
Direct or indirect ownership of an entity:
Equity stock, interest in a limited liability company, holding debt in an entity.
Direct or indirect compensation from an entity:
Physician’s compensation from an entity, lease between physicians and health care facilities, medical director agreements, and independent contract with physicians.
“Designated health services” (I)
Clinical laboratory services.
Physical therapy services.
Occupational therapy services.
Outpatient speech-language pathology services.
Radiology and certain other imaging services.
Radiation therapy services and supplies.
“Designated health services” (II)
Durable medical equipment and supplies.
Parenteral and enteral nutrients, equipment, and supplies.
Prosthetics, orthotics, and prosthetic devices and supplies.
Home health services.
Outpatient prescription drugs.
Inpatient and outpatient hospital services.
Penalties for Stark Violations
Payment for services in response to prohibited referral must ...
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
Compliance and Legal Risks in Laborist, Surgicalist, and Hospitalist Arrangem...MD Ranger, Inc.
Have you structured your hospital-based physician contracts to address all aspects of compliance?
Hospitalist agreements involve unique compliance and financial issues, particularly when global payments and advanced practice providers are involved. Risks include indirect compensation, billing and other compliance issues. This presentation will discuss compliance risks and provide guidance on how to structure compliant contracts and business arrangements.
Are you aware of Medicare Fraud and Abuse?Jessica Parker
Most physicians strive to work ethically, provide high-quality medical care to their patients, and submit proper claims for payment. Trust is at the core of the physician-patient relationship. The Federal Government also places enormous trust in physicians. Medicare and other Federal health care programs rely on physicians’ medical judgment to treat patients with appropriate, medically necessary services.
There were statutory amendments that HITECH required that were never made, and there was a interim final proposed rule that implements the HITECH Act breach notification requirements. These rules are now amended by the Omnibus rule, because they were confusing and garnered public comment that convinced HHS to make changes.
Epstein Becker & Green, P.C., is a national law firm with a primary focus on health care and life sciences; employment, labor, and workforce management; and litigation and business disputes. Founded in 1973 as an industry-focused firm, Epstein Becker Green has decades of experience serving clients in health care, financial services, retail, hospitality, and technology, among other industries, representing entities from startups to Fortune 100 companies. Operating in locations throughout the United States and supporting domestic and multinational clients, the firm’s attorneys are committed to uncompromising client service and legal excellence.
Office-Based Opioid Treatment: What You Need to Know: Trends in Behavioral He...Epstein Becker Green
Presented by David Shillcutt (Associate, Epstein Becker Green) and Kristina Sherry (Attorney, Nelson Hardiman) on April 4, 2019.
Office-based opioid treatment providers are on the front lines of the response to the opioid epidemic, but recent developments in federal and state legislation have significant implications for provider business models and service delivery strategies.
This webinar will examine provider capacity issues for medication assisted treatment, the opportunities and challenges of telemedicine for addiction services, and the expansion of innovative service delivery networks including the “Hub and Spoke” system and related models.
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/office-based-opioid-treatment-what-you-need-to-know-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Non-Compete and Trade Secrets Developments and Trends: A Year in Review and L...Epstein Becker Green
Epstein Becker Green Webinar - "Non-Compete and Trade Secrets Developments and Trends: A Year in Review and Looking Forward" - with Attorneys David J. Clark, J. William Cook, Aime Dempsey - January 29, 2019.
Issues arising from employees and information moving from one employer to another continue to proliferate and provide fertile ground for legislative action and judicial decisions. Many businesses increasingly feel that their trade secrets or client relationships are under attack by competitors—and even, potentially, by their own employees. Individual workers changing jobs may try to leverage their former employer’s proprietary information or relationships to improve their new employment prospects, or may simply be seeking to pursue their livelihood.
How can you put yourself in the best position to succeed in a constantly developing legal landscape?
Whether you are an employer drafting agreements and policies or in litigation seeking to enforce or avoid them, you will want to know about recent developments and what to expect in this area.
Join Epstein Becker Green attorneys David J. Clark, William Cook, and Aime Dempsey for a webinar providing insights into recent developments and expected trends in the evolving legal landscape of trade secret and non-competition law.
Visit https://www.ebglaw.com/events/non-compete-and-trade-secrets-developments-and-trends-a-year-in-review-and-looking-forward/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Drug Medi-Cal's ODS Waiver: Is Your Organization Ready for the Next Steps?Epstein Becker Green
Webinar presented by Kathryn F. Edgerton (Partner, Nelson Hardiman) and attorney Kevin J. Malone (Epstein Becker Green).
Part of a "first Thursdays" fall webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/one-in-three-californians-is-a-medi-cal-beneficiary-is-your-organization-ready-for-the-next-steps-in-drug-medi-cals-ods-waiver/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Mystified by MAT? Navigating the Changing Regulatory Landscape Around Medicat...Epstein Becker Green
Part of a "first Thursdays" fall webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
Presented by:
Francesca R. Ozinal – Associate, Epstein Becker Green
Andrew Martin – Chief Operating Officer, Behavioral Health Association of Providers
Despite reports identifying medication-assisted treatment (MAT) as a critical element of evidence-based treatment, confusion concerning who may dispense, associated compliance requirements, and the relationship between MAT provision and behavioral health providers continues to impede access to MAT.
This webinar will review key licensing and operational issues concerning the various types of MAT, including buprenorphine, naltrexone, and methadone, as well as misperceptions and key compliance issues in instituting MAT.
More info: https://www.ebglaw.com/events/mystified-by-mat-navigating-the-changing-regulatory-landscape-around-medication-assisted-treatment/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Employee Benefits and Executive Compensation - Private Equity Platform CompaniesEpstein Becker Green
Epstein Becker Green Webinar - "Proactive Compliance Initiatives for Private Equity Platform Companies" - with Attorneys Christopher A. McMican, Kevin J. Ryan, and Peter A. Steinmeyer - October 30, 2018.
Failure to comply with the host of state and federal rules and regulations that govern employee benefit plans and executive compensation arrangements can result in severe penalties and reduce investment value. Planning not only for a purchase transaction but also for integration and future operations is critical for an organization’s human capital success. Certain key issues must be analyzed regardless of whether stock or assets are purchased. The platform will need to consider Internal Revenue Code (“Code”) Section 401(k) and 403(b) plans, health plans, and bonus and other executive compensation arrangements (with potential Code Section 409A deferral restrictions), including any desired or necessary changes for streamlining, merging, terminating, or implementing new plans or perquisites. Consideration must be given to employment agreements and the various related continuity issues, including assigning contracts, non-compete provisions, and confidentiality clauses. Platforms operating in the health care space must also consider issues resulting from union activity (e.g., multiemployer health and pension arrangements, financial commitments, and withdrawal liability), excessive rates of employee turnover, strategical and hybrid formulas in retirement plans, and affiliated service group implications. State regulations that restrict ownership of certain health care professional corporations require resource allocation between medical service entities and management or staffing organizations, and, as a result, an understanding of the viable alternatives for structuring stock options and other equity components of the pay package for the key individuals is necessary.
The fifth webinar in this series will address various employee benefits and executive compensation issues that must be addressed by platform companies in their compliance efforts as they structure the transaction and move forward with operations. In addition to the challenges that normal buyers face in capital markets, this installment of the webinar series will explore the unique issues that platform companies will encounter in the health care sector. Navigating and planning for these issues will reduce financial risk and allow the platform to increase the attractiveness of its investment for continuing operations as well as for a potential exit strategy.
Visit https://www.ebglaw.com/events/proactive-compliance-initiatives-for-private-equity-platform-companies-employee-benefits-and-executive-compensation-compliance-and-planning/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Proactive Health Care Regulatory Compliance - Proactive Compliance Initiative...Epstein Becker Green
Epstein Becker Green Webinar - "Proactive Compliance Initiatives for Private Equity Platform Companies: Proactive Health Care Regulatory Compliance" - with Attorneys John W. Eriksen, Joshua J. Freemire, and Kevin J. Ryan - October 23, 2018.
While the platform proceeds with expansion and other accretive initiatives, it is also critical to establish a parallel work stream focused on the establishment or expansion of a platform’s compliance program commensurate with the platform’s existing and growing operations. The platform should have an appropriate compliance infrastructure, such as designated compliance personnel, training, background checks for employees, reporting mechanisms for employees, documented remediation of any identified issues, and ongoing self-audits of billing, coding, and documentation. Key subjects of compliance are fraud, waste and abuse, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the ability to respond to audits, licensure, the corporate practice of medicine, and other key regulatory compliance areas. Establishing and being able to demonstrate an effectively operating compliance function will help lower uncertainties and enhance a platform’s value upon an exit.
The fourth webinar in this series will address different approaches to enhancing compliance initiatives for platform companies to employ as they continue existing operations and expand operations via integrating new acquisitions. These proactive efforts can be effectuated in a cost-effective manner and be a key investment towards enhancing overall value of the growing platform.
Visit https://www.ebglaw.com/events/proactive-compliance-initiatives-for-private-equity-platform-companies-proactive-health-care-regulatory-compliance/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Webinar, 10/18: Attorney Bradley Merrill Thompson examines what the current process is for deciding when to recall a product and what the future holds.
Proactive compliance initiatives for private equity platform companies proac...Epstein Becker Green
Epstein Becker Green Webinar - "Proactive Employment Compliance: Proactive Compliance Initiatives for Private Equity Platform Companies" - with Attorneys Denise Dadika, Paul DeCamp, and Peter Steinmeyer - October 16, 2018.
Visit https://www.ebglaw.com/events/proactive-compliance-initiatives-for-private-equity-platform-companies-proactive-employment-compliance/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Add-On Diligence Strategy: Proactive Compliance Initiatives for Private Equit...Epstein Becker Green
Epstein Becker Green Webinar - "Proactive Compliance Initiatives for Private Equity Platform Companies" - with Attorneys Joshua J. Freemire, Anjana D. Patel, David E. Weiss - October 9, 2018.
Please join Epstein Becker Green attorneys for the webinar, "Add-On Diligence Strategy," one of five in a fall series that will address how proactive compliance initiatives are critical to a platform’s operations, expansion efforts, and eventual monetization upon exit.
Diligence efforts should continue in some documented form for a platform’s add-on and tuck-in acquisitions. It may appear to be less important to engage in due diligence beyond financial analysis if “it is just a small add-on,” but large potential exposures can still lurk regardless of a company’s size, and recovery from past owners (who may now be current employees) can be difficult at best.
The second webinar in this series will address different approaches to establishing a cost-effective assessment of the “compliance health” of smaller add-on (or tuck-in) targets, including the use of “SWAT” teams staffed in part by the company and in part by outside professionals.
Visit https://www.ebglaw.com/events/proactive-compliance-initiatives-for-private-equity-platform-companies-add-on-diligence-strategy/
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Immediate Post-Closing Operational Fixes: Proactive Compliance for Private Eq...Epstein Becker Green
Epstein Becker Green Webinar - "Immediate Post-Closing Operational Fixes: Proactive Compliance Initiatives for Private Equity Platform Companies" - with Attorneys John Eriksen, Josh Freemire, Gary Herschman, and Marc Mandelman - October 2, 2018.
Visit https://www.ebglaw.com/events/proactive-compliance-initiatives-for-private-equity-platform-companies-immediate-post-closing-operational-fixes/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Patient Brokering: SB1228 and Changes in California's Regulation of Addiction...Epstein Becker Green
Patient brokering, the practice of recruiting people in need of treatment for substance use disorders in exchange for kickbacks, has been a troubling practice in California, leading to concerns of patient endangerment and fraud.
This webinar will examine the implications of SB1228 and its impending changes to the rules governing marketing practices in residential and outpatient treatment, as well as sober living recovery residences. Also addressed will be problematic current practices and the future of compliant marketing relationships.
Presented by attorney Paul D. Gilbert of Epstein Becker Green and Harry Nelson of Nelson Hardiman.
Part of a "first Thursdays" fall webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/is-your-organization-at-risk-for-patient-brokering-preparing-for-sb1228-and-impeding-changes-in-californias-regulation-of-addiction-treatment-marketing/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Telehealth Portal Essentials – Telehealth Essentials for Start-Ups Crash Cour...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Francesca R. Ozinal - Telehealth Essentials for Start-Ups Crash Course Webinar Series - July 24, 2018.
Discussion Points:
* What business documents/policies need to be in place?
* Do I really need customized policies?
* How do I create consumer-friendly policies that are also compliant with the law?
Take a coffee break every Tuesday in July at 2 p.m. ET to join us for a 15-minute webinar covering telehealth and telemedicine issues!
https://www.ebglaw.com/events/telehealth-portal-essentials-telehealth-essentials-for-start-ups-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Non-Compete Agreements: Key Considerations for Health Care EmployersEpstein Becker Green
Epstein Becker Green "Industry Spotlights" Webinar with Attorneys David J. Clark, Denise Merna Dadika, Nathaniel M. Glasser, Kevin J. Ryan - July 24, 2018.
This webinar will provide an overview of the legal landscape of non-compete agreements in the health care industry, including state law requirements and restrictions, public policy considerations, recent developments, and expected trends. The webinar will also address key considerations when drafting and enforcing non-competes, engaging in the due diligence process, and integrating providers following a health care transaction.
Visit https://www.ebglaw.com/events/industry-spotlights-webinar-series-non-compete-agreements-key-considerations-for-health-care-employers/
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Choosing Initial and Expansion States for Your Telehealth Practice – Essentia...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Bradley S. Davidsen - Telehealth Essentials for Start-Ups Crash Course Webinar Series - July 17, 2018.
Discussion Points:
* Which model makes the most sense for my telehealth start-up to begin offering telehealth services: a one-state, surrounding states/regional, select states, or national model?
* If I want to expand slowly/regionally, what factors should I consider in determining which states should be part of my initial expansion?
* If I want to expand into a national model, what factors are important in choosing the first state(s) in which to practice? Which states should I expand into next? Why not start in all 50 states?
Take a coffee break every Tuesday in July at 2 p.m. ET to join us for a 15-minute webinar covering telehealth and telemedicine issues! https://www.ebglaw.com/crashjuly
https://www.ebglaw.com/events/five-factors-to-consider-when-choosing-initial-and-expansion-states-for-your-telehealth-practice-telehealth-essentials-for-start-ups-crash-course-webinar-series/
#telehealth #telemedicine #startups #healthcare #healthIT #physicians #hospitals #pharma #prescribing #healthtech #healthlaw
Recent Developments in Trade Secrets and Employee Mobility in the WorkforceEpstein Becker Green
Epstein Becker Green Webinar with Attorneys David J. Clark, J. William Cook, and Aime Dempsey - March 22, 2018.
Many businesses fear that their trade secrets and valued business relationships are at greater risk of attack by competitors – and even by their own employees. Do you know what it takes to protect those critical assets in the ever-changing world of trade secret and non-compete law?
Join Epstein Becker Green attorneys for a webinar as we take a look back into the impact we saw in 2017, discuss recent headlining cases, and provide insights into recent developments and expected trends in the evolving legal landscape of trade secrets and non-competition agreements.
Slides and more info: https://www.ebglaw.com/events/recent-developments-in-trade-secrets-and-employee-mobility-in-the-workforce-webinar/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Post-Acute Preferred Provider Arrangements – Strategies for Partnership: Post...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Clifford E. Barnes - Post-Acute Crash Course Webinar Series - November 28, 2017.
Discussion Points:
* Care coordination initiatives—an opportunity for more comprehensive care
* How Affordable Care Act demonstration projects, such as bundled payments, patient-centered medical homes, value-based purchasing, and accountable care organizations, promote preferred provider arrangements
* Opportunities for partnership, and how to approach them
* Balancing patient choice and preferred provider networks
* Why integration can be preferable to acquisition
Take a coffee break every Tuesday in November at 2 p.m. ET to join us for a series of four 15-minute webinars on "Transacting in the Post-Acute Care Space: Considerations, Red Flags, and Opportunities!"
https://www.ebglaw.com/events/post-acute-preferred-provider-arrangements-strategies-for-partnership-post-acute-crash-course-webinar-series/
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Post-Acute Care Deals – from Diligence to Closing: Post-Acute Crash Course We...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Alison M. Wolf - Post-Acute Crash Course Webinar Series - November 21, 2017.
Discussion Points:
* What are the regulatory red flags to look for before an acquisition?
* General fraud and abuse considerations for buyer’s counsel
* What regulatory approvals are required for closing a deal?
Learn more: https://www.ebglaw.com/events/post-acute-care-deals-from-diligence-to-closing-post-acute-crash-course-webinar-series/
Take a coffee break every Tuesday in November at 2 p.m. ET to join us for a series of four 15-minute webinars on "Transacting in the Post-Acute Care Space: Considerations, Red Flags, and Opportunities!"
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Post-Acute Care Overview and Industry Trends: Post-Acute Crash Course Webinar...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Anjana D. Patel - Post-Acute Crash Course Webinar Series - November 7, 2017.
Discussion Points:
* The definition and an overview of the “post-acute care continuum"
* A goals of care overview for the different types of post-acute care providers
* Recent trends and the drivers for change in the post-acute care industry
http://www.ebglaw.com/events/post-acute-care-overview-and-industry-trends-post-acute-crash-course-webinar-series/
Take a coffee break every Tuesday in November at 2 p.m. ET to join us for a series of four 15-minute webinars on "Transacting in the Post-Acute Care Space: Considerations, Red Flags, and Opportunities!"
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Signs You May Have a Problem: White-Collar Crash Course Webinar SeriesEpstein Becker Green
Epstein Becker Green Webinar with Attorney Richard W. Westling - White-Collar Crash Course Webinar Series - October 31, 2017.
Discussion Points:
* Why you can’t ignore internal complaints
* Early signs that you may be under investigation
* The first five things to do in response to an investigation
http://www.ebglaw.com/events/signs-you-may-have-a-problem-white-collar-crash-course-webinar-series/
Take a coffee break every Tuesday in October at 2 p.m. ET to join us for a 15-minute webinar covering white-collar and criminal enforcement issues!
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
NATURE, ORIGIN AND DEVELOPMENT OF INTERNATIONAL LAW.pptxanvithaav
These slides helps the student of international law to understand what is the nature of international law? and how international law was originated and developed?.
The slides was well structured along with the highlighted points for better understanding .
In 2020, the Ministry of Home Affairs established a committee led by Prof. (Dr.) Ranbir Singh, former Vice Chancellor of National Law University (NLU), Delhi. This committee was tasked with reviewing the three codes of criminal law. The primary objective of the committee was to propose comprehensive reforms to the country’s criminal laws in a manner that is both principled and effective.
The committee’s focus was on ensuring the safety and security of individuals, communities, and the nation as a whole. Throughout its deliberations, the committee aimed to uphold constitutional values such as justice, dignity, and the intrinsic value of each individual. Their goal was to recommend amendments to the criminal laws that align with these values and priorities.
Subsequently, in February, the committee successfully submitted its recommendations regarding amendments to the criminal law. These recommendations are intended to serve as a foundation for enhancing the current legal framework, promoting safety and security, and upholding the constitutional principles of justice, dignity, and the inherent worth of every individual.
PRECEDENT AS A SOURCE OF LAW (SAIF JAVED).pptxOmGod1
Precedent, or stare decisis, is a cornerstone of common law systems where past judicial decisions guide future cases, ensuring consistency and predictability in the legal system. Binding precedents from higher courts must be followed by lower courts, while persuasive precedents may influence but are not obligatory. This principle promotes fairness and efficiency, allowing for the evolution of the law as higher courts can overrule outdated decisions. Despite criticisms of rigidity and complexity, precedent ensures similar cases are treated alike, balancing stability with flexibility in judicial decision-making.
A "File Trademark" is a legal term referring to the registration of a unique symbol, logo, or name used to identify and distinguish products or services. This process provides legal protection, granting exclusive rights to the trademark owner, and helps prevent unauthorized use by competitors.
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How to Obtain Permanent Residency in the NetherlandsBridgeWest.eu
You can rely on our assistance if you are ready to apply for permanent residency. Find out more at: https://immigration-netherlands.com/obtain-a-permanent-residence-permit-in-the-netherlands/.
ASHWINI KUMAR UPADHYAY v/s Union of India.pptxshweeta209
transfer of the P.I.L filed by lawyer Ashwini Kumar Upadhyay in Delhi High Court to Supreme Court.
on the issue of UNIFORM MARRIAGE AGE of men and women.
Responsibilities of the office bearers while registering multi-state cooperat...Finlaw Consultancy Pvt Ltd
Introduction-
The process of register multi-state cooperative society in India is governed by the Multi-State Co-operative Societies Act, 2002. This process requires the office bearers to undertake several crucial responsibilities to ensure compliance with legal and regulatory frameworks. The key office bearers typically include the President, Secretary, and Treasurer, along with other elected members of the managing committee. Their responsibilities encompass administrative, legal, and financial duties essential for the successful registration and operation of the society.
2. Presented by
3
Epstein Becker Green
pgilbert@ebglaw.com
Nelson Hardiman
hnelson@nelsonhardiman.com
Paul GilbertHarry Nelson
3. 4
This presentation has been provided for informational purposes
only and is not intended and should not be construed to constitute
legal advice. Please consult your attorneys in connection with any
fact-specific situation under federal, state, and/or local laws that
may impose additional obligations on you and your company.
Cisco WebEx can be used to record webinars/briefings. By
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4. 5
Caveat: Questions of Statutory Interpretation
The SUPPORT Act, in large part because of the speed with which the
legislation was passed, presents a large number of interpretive questions
One of many open questions is whether the Eliminating Kickbacks in Recovery
Act applies to all clinical laboratories, or only to those that provide services to
a recovery home or clinical treatment facility
It seems that the legislative intent was to limit the reading of EKRA to only
laboratories receiving referrals from recovery homes and clinical treatment
Facilities
The purpose of the SUPPORT Act is, after all, to address the opioid epidemic
and concerns arising from referrals among recovery homes and clinical treatment
facilities
Clarity on this and many other important questions of statutory
interpretation will likely come through regulations and judicial decisions, although
it is possible that future legislation could also clarify the Act
5. Agenda
6
I. Background on H.R. 6 and the Eliminating
Kickbacks in Recovery Act
II. Context: Why was this necessary?
III. The Who, What, When of the Eliminating Kickbacks
in Recovery Act
IV. Implications for Addiction Treatment
V. Questions and Answers
7. 8
H.R. 6: The Substance Use Disorder Prevention that Promotes Opioid
Recovery and Treatment [SUPPORT] for Patients and Communities Act
(enacted October 24, 2018)
• Bipartisan
opioid crisis-
focused
legislation
• Follow up to
2016
Comprehensive
Addiction and
Recovery Act
(CARA)
• 58 separate
bills, 250+
pages
8. 9
Other highlights of H.R. 6’s 58 bills in fighting the
opioid crisis. . .
Jessie’s Law
(Reducing Privacy)
Partial Repeal of
IMD Exclusion
Expanded Access
to Medication
Assisted Treatment
(Buprenorphine)
Mandatory
E-Prescribing
Peer Support
Communities of
Recovery Act
Expanded
Telehealth
10. 11
1.Fraud: From intentional misrepresentation to submission of
unwarranted claim for payment
2.Abuse: Behavior inconsistent with sound fiscal, business, or
clinical practices, resulting in unnecessary cost/services and
lower quality
3.Waste: Ineffective treatment by financially-driven referral
patterns not focused on clinical needs
4.Safety: Patient deaths (overdose, suicidality,
mismanagement) resulting from inadequate clinical
oversight + inappropriate settings
5.Misdirection: Patients desperately needing addiction
treatment not getting it by getting redirected
Patient Brokering in Addiction Treatment:
An Old Problem driving New Public Concern
11. 12
• Enacted 1972
• 42 U.S.C. § 1320a-7b
• Prohibits knowing and willful conduct
• Prohibits giving or receiving payments or
remuneration directly or indirectly, overtly or
covertly, in cash or in kind
• Leading to claims on federal programs
• Safe harbors protect certain zones of accepted
activity
Federal Anti-Kickback Statute (“AKS”)
12. 13
Why the need for a new law to stop patient brokering?
Federal Anti-Kickback Statute
laws don’t apply to commercial or
employer funded health plans,
only federal health programs
Inconsistent state laws with gaps
and limited funds for
enforcement
Too little resources at the state
and local level
Federal law enforcement offers
resources and expertise to take
on the problem
13. 14
A decade of federal enforcement (of old laws) . . .
Since the late 2000s, the FBI and U.S. Department of
Justice have relied on older federal laws to prosecute
patient-brokering outside federal programs such as in
the area of Urine Drug Screening lab fraud, such as
the Travel Act, 18 USC § 1952 and the Wire Fraud
Act, 18 USC § 1343.
15. 16
makes it illegal to knowingly and willfully solicit, receive, offer,
or pay “remuneration” for referral or to induce a referral of a
patient to (or in exchange for a patient using) a:
• Recovery home
• Clinical treatment facility, or
• Laboratory
What is prohibited?
Section 220...
16. 17
• Clinical Treatment Facility: medical setting, other than a hospital, that provides
detox, risk reduction, outpatient, residential treatment, or rehabilitation for SUD
(licensed or certified)
• Recovery home: a shared living environment that is, or purports to be, free from
alcohol and illicit drug use and centered on peer support and connection to
services that promote sustained recovery from substance use disorders.)
• Lab (18 U.S.C. § 220(e))
Who?
Anyone who gives, gets, or tries to give or get remuneration for referrals to:
17. 18
Key Concept: Remuneration to Induce Referrals
Remuneration
• Cash
• Gifts
• Cash equivalents
• Anything of value
Inducement
• Something intended to
persuade someone
18. 19
Each violation is punishable by up to
10 years’ imprisonment and a $200,000 fine.
Consequences
19. 20
• Many states make the effective date
of new laws January 1 unless
otherwise stated or in cases of
emergency orders.
• The rule for federal laws is the
effective date of an act is on the
date of enactment.
• Since the law is silent, it was
effective as of October 24, 2018.
When does it take effect?
20. 21
• Expressly does not apply to
conduct that is prohibited under
the federal Anti-Kickback Statute
• Expressly does not preempt state
laws on the same subject matter.
Interaction with other laws
21. 22
• Applies to services covered by
any public or private plan or
contract, affecting commerce,
under which any medical benefit,
item, or service is provided to
any individual
• Covers commercial, employer-
sponsored, and government
health plans (unlike AKS)
• Exclusion of application to
conduct prohibited by the AKS
means, practically, new law
covers all other services
Limits of Application?
22. 23
Certain . . .
1. Payments to bona fide employees and independent contractors
(including services that meet the Federal AKS safe harbor for
personal services and management contracts)
2. Disclosed discounts under a healthcare benefit program
3. Discounts on drugs furnished under the Medicare coverage gap
discount program
4. Coinsurance and copayment waivers and discounts
5. FQHC arrangements that meet the Federal AKS exception
Statutory Exceptions:
25. 26
Using the federal AKS safe harbor standard as a
reference point for personal services contract
1. Written contract
2. Minimum 1 year term
3. If not full-time, specifying precise schedule of services
4. Detailing all services to be provided
5. Services do not involve promotion of illegal activity
6. Aggregate services are reasonably necessary to accomplish a commercially
reasonable purpose
7. Aggregate compensation set in advance, consistent with Fair Market Value
(FMV) and not taking into account the volume or value of any referrals
26. 27
…the law does not totally ban all payments to employees and
independent contractors for marketing services.
At the same time…
• Employers may pay employees and independent contractors for
admission and marketing services based on the fair market value of
the services provided to the facility at a commercially reasonable
rate.
• Employers unsure as to what constitutes the fair market value for
services at a commercially reasonable rate may wish to hire an
independent valuation expert to ensure that the employer is not
running afoul of the new law.
27. 28
The law prohibits…
The law prohibits employers paying employees and independent contractors based on the
following metrics:
1.The number of
individuals
referred
2. The number of
tests or
procedures
performed, or
3. The amount billed
or received from, in
part or in whole, the
health care benefit
program from the
individuals referred.
This means that employers may not pay employees or independent contractors a success bonus based on
any of these factors (in contrast to AKS allowance for productivity or incentive-based compensation
At the same time…
28. 29
Three principles
Bonus W2 Employees
Commercially reasonable; Allocation between salary and
bonus reasonable;
Bonus based on a number of
factors other than business
generated by the individual
employee
30. 31
• The new law makes it clear that it is a crime to offer patients a waiver or
discount of deductibles, co-insurance, and co-payments. The law provides
exceptions if such waiver or discount is not routinely provided and the
waiver or discount is provided in good faith. This means that addiction
treatment and recovery programs may provide discounts to patients with a
genuine, documented financial hardship.
• Additionally, the law prohibits offering anything of value to patients in
exchange for using the services of the recovery home, clinical treatment
facility, or laboratory. This means that it is a crime for programs or facilities
to pay for a patients’ travel to the facility.
Is it illegal to offer discounts to patients or pay for
patients’ travel?
31. 32
Client Inducements
Any item of value
that is given to a patient or
t the patient’s family to
influence their decision to
enroll at a specific
healthcare program.
32. 33
Airfare or Travel
• Forbidden to pay for travel in
order to enroll a patient into a
healthcare program.
• May be permissible to
establish a promissory note to
pay for up front costs.
Be careful, it must be legitimate.
33. 34
1. Consistently applied policy;
2. Value or volume of patients must not be tied to the decision to provide
transportation;
3. Cannot consist of air, luxury transport, or ambulance;
4. Cannot be marketed or advertised;
5. Can only be provided for established patients;
i. Up to 25 miles in urban areas;
ii. Up to 50 miles in rural areas;
6. The entity paying for the transportation must be the healthcare
provider.
Federal Healthcare Program Transportation
Terms for when free transportation may be given in federal health programs:
35. 36
• Health plans use advanced analytics to identify red
flags
• Referrals to state and local authorities to date have had
limited impact due to limited resources
• Insurance companies will be leading whistleblowers
initiating federal prosecution of patient brokering
Look for big uptick ahead in patient
brokering prosecutions
36. 37
• Statement from company leadership putting
pressure on marketers or incentivizing
marketers to bring in business will likely raise
concerns
Avoid Pressure or Statements that can be
misunderstood
37. 38
• It is critical that you know the specific anti-
kickback laws in your state
• If you conduct business in another state, you
must know those laws
Don’t Ignore State Anti-Kickback Laws
38. 39
• Waiving/discounting co-insurance, deductibles,
or other patient financial responsibility
• Urine drug screening
• Call center/Digital lead generations
• Referral fees with health professionals
High Risk Activities:
39. 40
• Procuring insurance for a patient so they can
attend a specific treatment program is
prosecuted as fraud and as a form of kickback.
High Risk Activities: Procuring Insurance
40. 41
• Any sort of quid pro quo arrangement where
payment for housing is made in return for a
patient referral
High Risk Activities: Bed Vouchers
41. 42
Last Word…
• We are going to see a sizeable number of federal prosecutions
in the coming 1-2 years.
• There is not a “one size fits all” approach, but there are right and
wrong ways to:
• Market behavioral health programs
• Attract clients/patients
• Work with marketing professionals
• “Everyone else is doing it” is not a legal defense.
• Pivot from a fear-driven or “ostrich” approach to a strategic one.
Deal with the “skeletons” in your organizational closet
42. 43
Assessing Risky Practices… beyond waiving financial
responsibility, bed vouchers, and procuring insurance….
• Lead Generation: Call centers and Digital lead
generators’
• Urine Drug Screening
• Relationships with healthcare providers and
professionals-Implants and more
43. 44
What is BHAP Doing?
• Guidance on fast changing legal and regulatory topics.
• C-ATM Certificate in Addiction Treatment Marketing
• PPCC Provider Payor Certificate of Compliance
• Educating the continuum of care on regulations and ethical best
practices
Strategic Partners:
Cooperative Entities:
45. How the Opioid Crisis and the SUPPORT Act
Created a New Enforcement Reality
When: February 7, 2019 from 12:00 p.m. - 1:00 p.m. EST
For more information and to register, please visit www.ebglaw.com/events.
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