Knowledge Library Monitoring and Auditing the Highest Compliance Risk Area: Physician Arrangements
Thursday, February 21, 2019

Monitoring and Auditing the Highest Compliance Risk Area: Physician Arrangements

Arrangements with referral sources that implicate the Anti-Kickback Statute and Stark Laws remain the number one healthcare enforcement priority for both the DOJ and OIG. Improper design and implementation of physician arrangements can result in penalties, denial of payments, and exclusion from federal health care programs. Health care organizations should ensure ongoing monitoring of this risk area with periodical audit verification of all arrangements with physicians to ensure they are compliant with both laws. Unfortunately, often this is not done as it should be, as Compliance Officers are reticent about reviewing work of legal counsel. Yet, virtually all the cases settled by DOJ and OIG were ones where legal counsel was involved. As such, these independent reviews are needed in order to ensure the arrangements meet fair market value, commercial reasonableness, as well as evidence performance on the agreements.

This webinar will review the four pillars supporting legitimate arrangements and this webinar will focus on them, as well as proper ongoing monitoring and independent audit verification and validation of the systems and processes supporting physician arrangements. Best practices will be suggested for implementing and auditing physician compensation arrangements to minimize liability exposure and penalties, including conducting compliance audits, instituting policies, and establishing ongoing monitoring and reviews.

Learning Objectives:

  • How settlements came about
  • Overview of Anti-Kickback Statute & Stark Laws
  • Standards for regulatory exceptions/safe harbors
  • Recent enforcement trends and CIAs
  • Differentiating monitoring and auditing processes
  • Process by which DOJ turns the case over to the OIG


Richard Kusserow, CEO at Strategic Management Services, LLC

Richard Kusserow, SMS CEO, previously served as DHHS Inspector General for 11 years that included issuing the Anti-Kickback Safe Harbors Rules and the passage and implementation of the Stark Laws.  He has published 8 books and numerous journal articles related to healthcare compliance.  He is regarded as an expert on those laws without peer. His firm of experts has assisted over 2,000 thousands of health care organizations with compliance advisory services.  He has a compliance blog published by Wolters Kluwer.

Jennifer Elko, JD, CHC, CHCP, CHRC, Senior Consultant at Strategic Management Services, LLC

Jennifer Elko, JD, CHC, CHCP, CHRC, is SMS Senior Consultant that has specialized in compliance program effectiveness evaluations with a focus on physician arrangement processes and systems. Engagements also include IRO reports and independent evaluations required under the CIAs including the review of physician arran gements for compliance with the federal Anti-Kickback Statute and Stark Law.

To view the webinar replay, please click the link below and complete the information. You will receive an email with a link to the webinar.

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