On December 2, 2021, the U.S. Department of Justice (DOJ) announced that it had entered into an $18.2 million settlement with Flower Mound Hospital, a 91-bed hospital located northwest of Dallas, to resolve claims that the hospital had violated the Stark Law, the Anti-Kickback Statute (AKS), and the False Claims Act (FCA) by making improper inducements to referring physicians. This Health Capital Topics article will review the facts underlying the settlement. (Read more...)

On November 30, 2021, the U.S. Supreme Court heard oral arguments regarding the challenges arising from the cuts made by the Centers of Medicare & Medicaid Services (CMS) to the 340B Drug Pricing Program. The 340B Drug Pricing Program allows hospitals and clinics that treat low-income, medically underserved patients to purchase certain “specified covered outpatient drugs” at discounted prices (applying a ceiling to what drug manufacturers may charge certain healthcare facilities) – 25% to 50% of what providers would typically pay – and then receive reimbursement pursuant to the rates set forth in the Outpatient Prospective Payment System (OPPS) at the same rate as all other providers. (Read more...)

A study released in the December 2021 issue of Health Affairs examined the correlation between hospital/health system ownership of physician practices and physician compensation. While a number of studies have analyzed the “rapidly growing trend” of vertical integration from the hospital/health system perspective, this is the first study to evaluate vertical integration from the physician practice perspective. This Health Capital Topics article will discuss the study’s findings and potential implications. (Read more...) 

Internists are considered part of the primary care industry, a service sector of growing importance to the healthcare delivery system despite increasing physician shortages. According to data from the American Board of Medical Specialties (ABMS), there are nearly 245,000 board-certified physicians in internal medicine. This third installment of the five-part series on the valuation of internal medicine services will discuss the competitive landscape of the providers of internal medicine. (Read more...) 
Is value-based reimbursement becoming a priority once more? An article authored by HCC President, Todd Zigrang, and HCC Senior Vice President and General Counsel, Jessica Bailey-Wheaton, was featured in the December 2021/January 2022 issue of St. Louis Metropolitan Medicine, published by the St. Louis Metropolitan Medical Society. Read the article entitled, CMS Innovation Center Launches “Bold New” Strategy.

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.