On November 20, 2020, the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) issued two final rules to modernize and clarify the Stark Law and the Anti-Kickback Statute (AKS). This is the third installment in a Health Capital Topics series examining these final rules and their impact on healthcare valuation going forward. This installment will summarize the new AKS Safe Harbors finalized by the OIG. (Read more...)

On January 14, 2021, the U.S. Department of Justice (DOJ) announced their recovery of $2.2 billion in settlements and judgments from civil cases involving fraud and false claims for fiscal year (FY) 2020. Approximately $1.8 billion was recouped from the healthcare industry for federal losses alone, and included recoveries from drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians. (Read more...)

On December 16, 2020, CMS released their National Healthcare Expenditures (NHE) report. The recent analysis conducted by the Office of the Actuary at CMS found that NHE grew 4.6% between 2018 and 2019. This rate is essentially the same as in 2018 and is consistent with the growth reported since 2016. In 2019, NHE was $11,582 per person, an increase from 2018 of over $400 per person. Further, NHE comprised 17.7% of the U.S. gross domestic product (GDP), which is also similar to the proportion of 17.6% reported in 2018, and confirms that healthcare spending is increasing at a faster rate than the nation’s GDP is growing. (Read more...) 

The final installment in this five-part Health Capital Topics series on the valuation of telemedicine will focus on the technology available to telemedicine providers, how that technology has evolved, and its anticipated development going forward. The first installment in this series introduced telemedicine and its increasing importance to, and popularity among, providers and patients, as well as the current and future challenges related to telemedicine. The second installment took a deeper dive into the reimbursement environment in which telemedicine providers operate; the third installment examined telemedicine’s regulatory environment, with a specific focus on fraud and abuse laws; and, the fourth installment discussed supply and demand related to telemedicine, as well as how telemedicine may change healthcare competition generally. (Read more...) 
"Hospitals Increasingly Seek Physicians as CEOs," 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 St. Louis Metropolitan Medical Society in The St. Louis Metropolitan Medicine Magazine.

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.