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The Road Ahead for Health Care Compliance

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Frank Sheeder
Frank Sheeder

The Health Care Reform Package has significant implications for health care compliance professionals. This presentation addresses many of the issues that they will be compelled to face right away, and in the next several years.

Notícias e política
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Kevin D. Lyles, Esq. [email_address] (614) 281-3821 Enforcement and Economic Challenges The Road Ahead and How to Navigate It Diane Meyer, CHC [email_address] (650) 724-2572 Frank E. Sheeder, Esq. [email_address] (214) 969-2900
Agenda ,[object Object],[object Object],[object Object]
General Environment ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Private Practice of Medicine is Under Attack ,[object Object],[object Object],[object Object],[object Object]
The Private Practice of Medicine is Under Attack ,[object Object],[object Object],[object Object],[object Object]
Fraud Enforcement and Recovery Act of 2009 (“FERA”) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
FERA Amendments to the FCA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
After FERA, many indirect recipients of federal funds have FCA exposure ,[object Object],[object Object],[object Object]
Intent to Obtain Government Money Eliminated ,[object Object],[object Object]
Added language for claims to contractor, grantee, or other recipient ,[object Object],[object Object],[object Object]
Expanded exposure for “reverse false claims” ,[object Object],[object Object],[object Object],[object Object],[object Object]
Expands “reverse false claims” to liabilities that are not “fixed” ,[object Object],[object Object],[object Object],[object Object],[object Object]
Other Expansions ,[object Object],[object Object],[object Object],[object Object]
How to respond to FERA ,[object Object],[object Object],[object Object],[object Object],[object Object]
Health Care Reform ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA ,[object Object],[object Object],[object Object],[object Object],[object Object]
Information Technology ,[object Object],[object Object],[object Object],[object Object]
HITECH Act ,[object Object],[object Object]
HITECH Act ,[object Object],[object Object],[object Object]
Tax exemption ,[object Object],[object Object],[object Object],[object Object],[object Object]
Tax exemption ,[object Object]
Tax exemption ,[object Object],[object Object],[object Object],[object Object]
Medical Device and Pharmaceutical Companies: Physician Relationships ,[object Object],[object Object],[object Object]
Accountable Care ,[object Object],[object Object]
What is an Accountable Care Organization (ACO) ,[object Object],[object Object],[object Object],[object Object]
Current and Future ACOs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Advantages ,[object Object],[object Object],[object Object],[object Object],[object Object]
Challenges/Barriers ,[object Object],[object Object],[object Object],[object Object]
Accountable Care Organization Model Accountable Care Organization Medicare and Potentially Other Payors Physician Investors Hospital Payor Contracts Patients Equity Investment Equity Investment
Organizational Considerations ,[object Object],[object Object],[object Object],[object Object]
Other Legal Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stark Law CMP Anti-Kickback Antitrust
Physician Practice Acquisitions ,[object Object],[object Object],[object Object]
Common Issues in Practice Acquisitions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Common Issues in Practice Acquisitions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Service Line Co-Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Service Line Co-Management Model Management Company, LLC Appropriate equity split Hospital Governing Board Physician Investors Hospital Orthopedic/Cardiovascular Service Line Agreement to manage Service Line Management Fee – 50% fixed, 50% based on performance incentives Appropriate governance split Mgmt. Co. reports to Hospital Bd.
PPACA Implementation Timeline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA Implementation Timeline ,[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA Implementation Timeline ,[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA Implementation Timeline ,[object Object],[object Object],[object Object],[object Object]
PPACA Implementation Timeline ,[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA Implementation Timeline ,[object Object],[object Object],[object Object],[object Object]
PPACA Implementation Timeline ,[object Object],[object Object],[object Object],[object Object],[object Object]
PPACA Implementation Timeline ,[object Object],[object Object],[object Object]
PPACA Implementation Timeline ,[object Object],[object Object],[object Object],[object Object]
PPACA Implementation Timeline ,[object Object],[object Object]
PPACA ,[object Object],[object Object]
Responses and Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Thank you. Questions? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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The Road Ahead for Health Care Compliance

  • 1. Kevin D. Lyles, Esq. [email_address] (614) 281-3821 Enforcement and Economic Challenges The Road Ahead and How to Navigate It Diane Meyer, CHC [email_address] (650) 724-2572 Frank E. Sheeder, Esq. [email_address] (214) 969-2900
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  • 50. Accountable Care Organization Model Accountable Care Organization Medicare and Potentially Other Payors Physician Investors Hospital Payor Contracts Patients Equity Investment Equity Investment
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  • 57. Service Line Co-Management Model Management Company, LLC Appropriate equity split Hospital Governing Board Physician Investors Hospital Orthopedic/Cardiovascular Service Line Agreement to manage Service Line Management Fee – 50% fixed, 50% based on performance incentives Appropriate governance split Mgmt. Co. reports to Hospital Bd.
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