Physicians and Other Healthcare Providers: Beware “Eat What You Kill” Compensation Models

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By Kim Stanger

Physicians and other healthcare providers often structure their group compensation formulas on an “eat what you kill” basis, i.e., a provider is paid based on the services he or she performs in addition to items or services they order, prescribe, refer, sell, etc. Such formulas must be reviewed, structured, or revised appropriately to ensure compliance with federal fraud and abuse laws, including Stark, the Anti-Kickback Statute (AKS), and the Eliminating Kickbacks in Recovery Act (EKRA). Read more

Gifts to Patients and Referring Providers

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By Kim Stanger

At this time of year, healthcare providers may want to give gifts to patients, referring providers, or other sources of business, but such gifts may violate federal and state fraud and abuse laws and result in civil or criminal fines for both the giver and receiver. Read more

Small Win for Healthcare Providers: CMS Issues New Guidance under No Surprise Billing Rules and DHHS’ Appeal

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By Allison (Ally) Kjellander and Kim Stanger

On April 12, 2022, CMS issued new guidance1 for the independent dispute resolution (“IDR”) process under the No Surprise Billing Rules (“Rules”) in response to a U.S. District Court for the Eastern District of Texas judge vacating an insurer-friendly provision,2 handing a small win to healthcare providers. Read more

No Surprise Billing Rules: Good Faith Estimates and Unscheduled Services

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By Kim Stanger

The No Surprise Billing Rules took effect January 1, 2022, but many questions remain, including if and to what extent the new rules for good faith estimates apply to items or services that are provided to self-pay patients on an unscheduled basis, such as emergency, urgent care, or walk-in patients. Read more

No Surprise Billing Rules: Checklist for Providers

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By Kim Stanger

Many providers make the No Surprise Billing Rules more complicated and expansive than they are. To help healthcare providers and facilities understand, implement and monitor compliance with the new rules, Holland & Hart has prepared a short guide and checklist for compliance, available here.