This seminar discussed current developments in health care regulation and compliance for hospitals. Please view all of the recorded presentations on our Vimeo channel.
This year's topics included:
2012 Health Care Litigation in Review
- Round-up of hospital litigation trends
- Litigation challenging Health Care Reform and Obamacare
- Department of Justice (DOJ) challenge to Blue Shield's "most favored nations clause" with hospitals: What can hospitals do?
- California Attorney General (AG) investigation of hospital system's requiring payors to contract with all hospitals in order to get access to one hospital; Bundling multiple services for one (low) price
- Data breach litigation
- Federal Trade Commission (FTC) enforcement of hospital mergers and affiliations; What kinds of hospital cases does the FTC pursue?
What's Up with Hospital-Physician Transactions?
- Establishing fair market value (FMV)
- Thorny Stark problems and creative fixes; Real-life examples
- Pay-for-performance update; Trending to reward Value—legal issues
- Transactions with Physician-Owned Distributors (PODs): How risky are they?
- "Auditing" your physician contracts—do's and don'ts
- Recent changes in the Stark regulations
- Government enforcement trends
- Voluntary disclosures to the government
- Evolving best practices for Stark compliance
Internal Compliance Investigations
- The benefits and risks of conducting internal investigations in hospitals
- Who should direct and conduct internal investigations
- How to formulate an investigative plan
- Proper methods for conducting witness interviews
- Potential consequences of prosecution and methods to avoid or mitigate impacts of prosecution
- Protecting privileged materials created during the investigation
Update on Federal and State Audit Programs: RACs, MACs, MICs, ZPICs, and Medi-Cal
Kathy Drummy and Adam Romney
- Changes and recent developments in the Medicare RAC programs; Part A and Part B RACs; Rollout of the RAC program to the Medicare Part C and D programs
- Update on Medi-Cal audit programs; Rollout of the RAC program to Medi-Cal
- Overview and update of other federal audit programs: Medicare Administrative Contractors (MACs), Medicaid Integrity Contractors (MICs), Zone Program
- Integrity Contractors (ZPICs) and the new CMS anti-fraud command center in Baltimore
- Coordination of Look Backs and overpayment time periods
ACO Lessons Learned: MSSP and Commercial
Bob Homchick and Bob Schuchard
- Medicare SSP ACOs vs. Commercial ACOs: What are the typical requirements of each? What is different between the two forms of ACOs? The application process for MSSP
- ACO Challenges in formation: What are we seeing? What have been the hurdles? Tax exemption issues—operating in the Medicare and commercial and payor worlds
- ACO Fraud & Abuse (F&A) Waivers: What are the five F&A Waivers applicable to MSSP ACOs? What are the F&A risks?
- ACO operational issues: Attribution of beneficiaries; Physician exclusivity
The Long-Awaited Final HIPAA "Omnibus" Rule Has Been Published
- New business associate obligations and contract provisions
- New breach notification requirements
- The good news and the bad news on changes to uses and disclosures
- Increased individual rights
- New enforcement requirements