Healthcare Credentialing | symplr Blog

Compliance Program Effectiveness

Written by Kesha Boykin-McLean | Oct 22, 2014 3:11:00 PM

So your legal department has a process for contracting with physicians or referral sources. Where do you fit in the process?

Last week we listed 10 things to consider when contracting with physician-owned entities that was discussed at the Health Connect Partners (HCP) Hospital and Healthcare I.T. Conference. The first on the list was to consult with your legal department because your facility will likely have an established process for executing contracts. Anytime you initiate or renew an arrangement with a vendor, you engage your contracting process. It important to note that not all contracts look like contracts and not all physicians’ look like physicians or referral sources. Take care to avoid verbal agreements with physicians or potential referral sources because these arrangements can become contracts. Most Hospital’s strictly prohibit side agreements or arrangements (written or oral) with physicians or physician-owned entities and non-physician referral sources. Note that letters of intent, letter agreements, or memorandums of understandings are all contracts under the self-referral laws. Payments of any kind should never be made prior to written approval of a contract signed by your legal department or other approving authority. Anti-Kickback Statue (AKS) and Stark Laws apply to immediate family members of physicians as well. Immediate family members are defined by the law as spouse; natural or adoptive parent; child, or sibling; stepparent, stepchild, stepbrother or stepsister; father-in-law, mother-in-law, son-in-law, daughter-in-law, bother-in-law, or sister-in-law; grandparent or grandchild; and the spouse of a grandparent or grandchild.

It is important to constantly evaluate your process and understand your role.