Apr 23 2019

Forest Park Medical Center and the Travel Act: Different Road, Same Destination

Healthcare fraud convictions are news. When the convicted parties are physicians, investors and staff of a physician-owned surgical hospital who now face up to sixty-five years in a federal penitentiary, that is big news. And when some of those convictions were based, in part, on a relatively obscure federal law that appears to expand the reach of federal prosecutors to include commercial and private-pay business that many assumed would fall outside of federal jurisdiction, that really has the industry buzzing.

The case in point, involving Forest Park Medical Center ("FPMC"), is not as earth-shattering as some make it out to be, however. To be sure, this case is a wake-up call for providers who believe that they can avoid liability under federal fraud and abuse laws if they do not accept Medicare or Medicaid patients or otherwise carve out federal program beneficiaries. But it also serves as a reminder that sham arrangements that are intended to compensate physicians to steer patient referrals invariably place the participants at risk of prosecution. This Legal Update explores the background to the Forest Park case and the state and federal statutes upon which the prosecutors relied, and then discusses key implications and takeaways for reviewing existing contractual relationships and internal compliance programs in response to these developments.

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Dec 07 2015

CMS Finalizes Two New Exceptions and Modifications to the Stark Law

The Centers for Medicare and Medicaid Services (CMS) recently published its final rule modifying several aspects of the federal physician self-referral law (the "Stark Law") and adding two new exceptions: one for recruitment of non-physicians providing primary care and the other for timeshare arrangements.

For the most part, CMS's changes lessen the Stark Law's compliance burden and aim for uniformity among the exceptions. At the same time, the two new exceptions create additional compliance and monitoring requirements for individuals and entities wishing to take advantage of the exceptions.

Most of the changes are effective January 1, 2016.

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