On April 18, 2022, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) published Advisory Opinion (AO) No. 22-09 analyzing a proposed business arrangement involving a testing laboratory contracting with hospitals for specimen collection and testing. This AO is an extension on earlier opinions and guidance, and is yet another blow for laboratory arrangements. This Health Capital Topics article reviews the AO and what clinical labs should expect. (Read more...)

On April 11, 2022, the U.S. Department of Justice (DOJ) intervened in an ongoing lawsuit against Methodist Le Bonheur Healthcare (Methodist). The lawsuit was originally filed in 2017 by two relators, a former Methodist executive leadership team member and the former CEO for Methodist University Hospital. The crux of the relators’ complaint was that Methodist induced the referrals of cancer patients to their facility through kickback payments made to The West Clinic (West), in violation of fraud and abuse laws. (Read more...)

On April 18, 2022, the Centers for Medicare & Medicaid Services (CMS) released its proposed rules for payment and policy updates to the Medicare Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year (FY) 2023. This Health Capital Topics article discusses the various provisions outlined in CMS’s proposed rule. (Read more...) 

As of 2020, nearly 11,500 Medicare-certified home health agencies (HHAs) were operating in the U.S. As the Baby Boomer cohort ages, competition among HHAs (and other entities that provide similar services) may increase due to a growing patient pool requiring chronic disease management. This competition for patients, in addition to a shift in patient preference for home-based care over institutional care, may create a gap between the demand for home healthcare services and the supply of adequate personnel to meet that demand. (Read more...) 
"Study: Vertical Integration Not Financially Beneficial for Physicians" authored by HCC President, Todd A. Zigrang, MBA, MHA, FACHE, CVA, ASA, and, HCC Vice President and General Counsel, Jessica Bailey-Wheaton, Esq., was published by the St. Louis Metropolitan Medical Society in the April/May 2022 issue of St. Louis Metropolitan Medicine.

For more recently published material written by HCC, please visit www.healthcapital.com

This one-hour webinar provides legal and valuation perspectives on the finalized changes to the Stark Law and the Anti-Kickback Statute. Specific issues covered include:

  • The changes to the “big three” requirements – Fair Market Value, Commercial Reasonableness, and the Volume or Value Standard;
  • The new exceptions and safe harbors for value-based arrangements, including where the Stark Law and Anti-Kickback Statute final rules differ; and
  • Other new and modified exceptions and safe harbors included in the final rules.