By Kim Stanger

Physicians and other healthcare providers often structure their group compensation formulas on an “eat what you kill” basis, i.e., a provider is paid based on the services he or she performs in addition to items or services they order, prescribe, refer, sell, etc. Such formulas must be reviewed, structured, or revised appropriately to ensure compliance with federal fraud and abuse laws, including Stark, the Anti-Kickback Statute (AKS), and the Eliminating Kickbacks in Recovery Act (EKRA). Continue reading →

By Kim Stanger

At this time of year, healthcare providers may want to give gifts to patients, referring providers, or other sources of business, but such gifts may violate federal and state fraud and abuse laws and result in civil or criminal fines for both the giver and receiver. Continue reading →

By Allison (Ally) Kjellander and Kim Stanger

On April 12, 2022, CMS issued new guidance¹ for the independent dispute resolution (“IDR”) process under the No Surprise Billing Rules (“Rules”) in response to a U.S. District Court for the Eastern District of Texas judge vacating an insurer-friendly provision,² handing a small win to healthcare providers. Continue reading →

By Kim Stanger

This week, rural providers began receiving the next round of Provider Relief Funds as authorized by the CARES Act. Recipients include rural acute care general hospitals, critical access hospitals (“CAHs”), rural health clinics (“RHCs”), and community health centers located in rural areas. Rural hospitals and CAHs may receive a minimum of $1,000,000 plus additional amounts based on a percentage of their annual expenses. RHCs and CHCs will receive a minimum of $100,000 plus an additional amount based on their operating expenses. The funds are generally made by direct deposit. The disbursement is described here. Continue reading →

By Melissa Lou, Kim Stanger, and Christopher Mack

Clients frequently ask us how long they should retain medical records and related business records.  The answer depends on various factors, including the type of record, applicable regulatory and contract requirements, and the provider’s risk tolerance and resources.  Nevertheless, state record retention guides may be valuable to clients as they consider their internal policies.  The Idaho, Utah, and Wyoming state charts below are intended as a guideline.  Providers should confirm laws that may apply in their particular state, or that may apply to their particular situation. Continue reading →