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 second installment in a Health Capital Topics series examining these final rules and their impact on healthcare valuation going forward. The first article provided an overview of the Stark Law and summarized the law’s final rule as relates to “The Big Three” Requirements – Commercial Reasonableness, the Volume or Value Standard and the Other Business Generated Standard, and Fair Market Value. This second article will summarize the new Stark Law exceptions finalized by CMS. (Read more...)

CMS recently released the final rules for the calendar year (CY) 2021 Medicare Physician Fee Schedule (MPFS), Hospital Outpatient Prospective Payment System (OPPS), and Ambulatory Surgical Center (ASC) Payment System. The final rules generally remained unchanged from their proposed versions, with a couple of exceptions. This Health Capital Topics article will briefly review those major changes and the possible impacts of CMS’s CY 2021 final rules, which will go into effect on January 1, 2021. (Read more...)

The Biden Administration has put forth their healthcare plan, which seeks to expand access to affordable healthcare by: (1) upholding and expanding the Patient Protection and Affordable Care Act (ACA), to reduce the amount that consumers pay for health insurance on the individual marketplace; (2) offering a new, public insurance option similar to Medicare; (3) prohibiting the practice of “surprise billing”; (4) leveraging the Department of Justice’s (DOJ’s) and Federal Trade Commission’s (FTC’s) antitrust authority to target market concentration within the healthcare system; and, (5) driving down prescription drug prices by increasing competition for, and regulation, of pharmaceutical companies. (Read more...) 

The fourth installment in this five-part Health Capital Topics series on the valuation of telemedicine will focus on the competitive environment in which telemedicine providers operate. 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, including before and during the COVID-19 pandemic, while the third installment examined telemedicine’s regulatory environment, with a specific focus on fraud and abuse laws. (Read more...) 
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.


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