Wednesday, November 15, 2023 1:00PM EST; 12:00PM CST; 11AM MST; 10AM PST

The predominant basis for federal fraud and abuse enforcement and settlements is the False Claims Act. While most of those enforcements and settlements turn on things like failing to perform services or under-documentation of the service billed, there are a host of requirements pertaining to clinical quality that can lead to false claims and other forms of fraud and abuse liability. In this crisp half hour program with a 17 page substantive handout and fifteen minutes for Q & A, Alice elucidates these little appreciated risks which merit focused attention from all providers.

- Conditions of participation and the new risks associated with medical necessity - Quality reporting and pay for performance issues
- Value-based arrangements and enterprises
- Other forms of quality failures
- Penalties including exclusions, sanctions, quality-based civil money penalties, quality-based corporate integrity agreements, false claims liability -- including caselaw
- Government guidance
- Practical steps

(Recording) Clarifying Questions About The No Surprises Act (NSA); Tuesday, June 7, 2022 Presenter: Dan Shay $250.00 (Recorded) Many law firms are offering presentations on this confounding statute and regulations. We are taking a different approach. While the rules on balance billing are restricted to some providers, the rules on charge transparency for cash paying patients are far broader affecting physician practices and others besides hospitals. Dan Shay will clarify 6 common questions about the NSA, including a 14 page handout.
(Recording) Avoiding Modern Physician Compensation Pitfalls; Tuesday, June 14, 2022 Presenter: Alice Gosfield $250.00 (Recording) It has been more than ten years since Alice Gosfield has done a teleconference focused specifically around physician compensation. In this presentation with a 12 page handout (including links to 6 related more in-depth articles), she reviews 8 types of physician payment revenues from FFS to case rates, bundled payments, gainsharing and more. She points out the perverse incentives of each, but also, what payer contract terms are essential to protect against pitfalls in each approach.
(Recorded) HIPAA in The Social Media Context; Tuesday, October 19, 2021 Presenter: Dan Shay $275.00 The Health Insurance Portability and Accountability Act (HIPAA) and its regulations have existed for over 20 years, but remain confusing for many health care providers. Updates have been issued over the years, but the health care industry and the world have changed dramatically in that time.
(RECORDED) Stark 1; Tuesday, January 19, 2021 Presenter: Alice $250.00 Redefined financial terms: commercial reasonableness, volume or value; Permitted directed referrals; Group practices: profit shares, productivity bonuses; In handout only: decoupling from AKS, definitions of DHS, physician, remuneration.
(RECORDED) Stark 2: Friday, January 22, 2021 Presenter: Alice $250.00 Fixing Problems: Isolated Transactions, period of disallowance, writing and signature requirements, limited remuneration to a physician; Fair Market Value Redefined Generally; Revised Fair Market Value Compensation Exception; In handout only: ownership or investment; rent of space and equipment; physician recruitment; payments by a physician; recruitment assistance for NPPs; updated obsolete references.
(RECORDED) AKS: Tuesday, January 26, 2021 Presenter: Dan $250.00 Revised Safe Harbors: Personal Services and Management Contracts & Outcomes-Based Payment Arrangements: Increased flexibility in personal services/management contract safe harbor requirements, new outcomes-based payment arrangements sub-safe-harbor; Local Transportation: relaxed requirements and expanded geographic areas; New Safe Harbors: Arrangements for Patient Engagement and Support to Improve Quality, Health Outcomes and Efficiency, CMS-Sponsored Model Arrangements and CMS-Sponsored Model Patient Incentives; Civil Money Penalties: Telehealth Technology for Dialysis; In handout only: warranties, ACO beneficiary incentive payment.
(RECORDED) EMR & Cybersecurity: Thursday, January 28, 2021 Presenter: Dan $250.00 AKS and Stark EMRs: changes to when recipients must pay 15% contribution, Areas of overlap between AKS and Stark; Differences and distinctions between revisions and their significance; AKS and Stark Cybersecurity, Areas of overlap between AKS and Stark, Differences and distinctions and their significance.
(RECORDED) Value-based Arrangements: Tuesday, February 2, 2021 Presenter: Alice $250.00 What is permitted and encouraged; Why two sets of rules; Critical definitions: e.g. VBA, VBE, target population; 3 safety zones specified, Full financial risk, substantial downside risk, coordination and management of care: the small physician practice option; Excluded entities excluded how: e.g., pharma, lab companies, PBMs, DMEPOS; Limited technology participants; How to apply the rules.
Unraveling The Pitfalls in Medicare Physician Office Diagnostic Testing (Recorded) $275.00