At the Health Connect Partners (HCP) Hospital and Healthcare I.T. Conference meeting, we discussed Contracting with Physician-owned Entities and how your compliance program can implement safeguards to ensure that you don’t run afoul of the Anti-Kickback Statue (AKS) and Stark Laws. The Office of Inspector General (OIG) announced that it has moved to evaluating compliance program effectiveness during investigations. So it isn’t enough to have the appropriate policies and procedures in place. Instead we must continually monitor and evaluate the effectiveness of our processes. The Government looks at a number of factors when evaluating agreements with physician-owned companies.
The following list of questions are some you should ask yourself when auditing your contracts with referral sources to ensure that your processes are effective:
Were the services provided at fair market value. Can you support the valuation with documentation?
Was the contract with someone on your active medical staff?
Was the contract in writing and for at least one year?
Were any payments issued prior to execution date of contract?
Does there appear to be a direct relationship between the number of referrals and payments to the service center. How is the arrangement structured?