decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Hospital Model Compliance Plan / Risk areas / Referral regulations - The Stark self-referral rule and the Anti-Kickback Statute
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Article Overview
This article explains how hospitals can reduce compliance risk under the Stark self-referral framework and the Anti-Kickback Statute. It focuses on common business arrangements that warrant review, including financial relationships, physician compensation, recruitment, discounts, credentialing, malpractice insurance subsidies, and other provider relationships. The discussion is aimed at hospital compliance staff, coding/compliance professionals, and administrators who oversee referral-related contracts and payment arrangements.
Why This Topic Matters
Hospitals routinely enter into financial and operational relationships that can trigger referral-law scrutiny. Understanding the article helps readers identify the general compliance areas that need review and the types of arrangements that may require closer oversight.
Article Sections
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Hospital compliance risks under referral and anti-kickback rules
Introduces the need for hospitals to monitor business arrangements with other providers and maintain compliance with federal referral laws.
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Stark self-referral considerations
Summarizes hospital concerns related to financial relationships, written agreements, and arrangements that must fit within applicable Stark exceptions.
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Anti-Kickback Statute risk areas
Outlines several categories of business relationships that may warrant special review under anti-kickback guidance, including joint ventures, compensation, recruitment, discounts, credentialing, and insurance subsidies.
What You Will Learn
- The general compliance issues hospitals must consider when entering into referral-related business arrangements.
- The broad categories of arrangements highlighted as higher-risk under federal fraud and abuse guidance.
- Why written agreements, compensation structures, recruitment plans, and provider relationships require careful review.
- How hospitals can use safe harbor and exception concepts as part of their compliance oversight.
Who Should Read This
- Hospital compliance officers
- Health care administrators
- Revenue cycle and billing professionals
- Physician practice managers
- Fraud and abuse compliance staff
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