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Anti-Kickback Statute and Stark Law Compliance in Managed Care Contracts

Navigating Safe Harbors and Physician Incentive Plan Rules, Limiting Civil Monetary Penalty Exposure

Recording of a 90-minute CLE video webinar with Q&A

This program is included with the Strafford CLE Pass. Click for more information.
This program is included with the Strafford All-Access Pass. Click for more information.

Conducted on Wednesday, May 31, 2023

Recorded event now available

or call 1-800-926-7926

This CLE course will guide healthcare counsel on ensuring compliance with the Anti-Kickback Statute (AKS) and Stark law in managed care contracting and downstream provider arrangements. The panel will also provide best practices for counsel on structuring arrangements to fit within the AKS safe harbors and Stark exceptions and the applicable physician incentive plan rules.

Description

As providers enter into new payment models, it is important to remember that payment models need to remain compliant with the fraud and abuse laws, including the AKS and Stark laws. The AKS and Stark laws provide several safe harbors and exceptions that shield certain alternative payment arrangements from the prohibitions outlined by the AKS and Stark. These safe harbors, such as those for eligible managed care organizations, create flexibility in managed care contracting and allow payment arrangements that could otherwise present a risk of violating the AKS.

Counsel for healthcare providers and payers must consider the AKS and Stark law requirements and the safe harbors and exceptions when contracting with managed care companies and when structuring downstream arrangements with providers. Counsel must also understand when physician incentive payments are subject to Civil Monetary Penalty (CMP) Statute liability, or conversely, are protected under the PIP rules.

Listen as our authoritative panel of health law counsel reviews the various AKS safe harbors potentially applicable to managed care arrangements and downstream provider arrangements. The presenters will address situations that trigger Stark concerns, examine the Stark exceptions for managed care arrangements and safe harbors, and discuss the CMP Statute and the PIP rules. The panel will also outline guidance for counsel to healthcare providers and payers on structuring arrangements to fit within the AKS safe harbors and Stark exceptions and the PIP rules for managed care contracting.

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Outline

  1. Application of the AKS, Stark laws, and applicable safe harbors and exceptions
  2. Physician incentive plan rules
  3. Civil monetary penalty exposure

Benefits

The panel will review these and other key issues:

  • When does a risk-sharing arrangement between a managed care organization and a physician constitute a financial arrangement under Stark?
  • What rules are applicable when structuring downstream provider arrangements?
  • What is the scope of the AKS and Stark safe harbors and exceptions?
  • What are the exceptions and safe harbors in AKS and Stark that create flexibility for managed care contracts and downstream provider arrangements?

Faculty

Shalom, Alexandra
Alexandra B. Shalom
Attorney
Foley & Lardner

Ms. Shalom focuses on counseling clients in the health care, pharmacy, and medical device industries with respect to a...  |  Read More

Young, Torrey
Torrey K. Young
Partner
Mukasey Frenchman

Ms. Young represents clients in the health care and life sciences industries. A leader in her field, she has a wealth...  |  Read More

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Strafford will process CLE credit for one person on each recording. All formats include course handouts.

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