Stark Integrity

Latest Episodes:

Part 1: Interplay between Peer Review and Compliance, False Claims Act, and Stark Law Sep 20, 2022

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Physician activities reviewed through the Peer Review process may pose liability under the False Claims Act - including the Stark Law. In this episode, Captain Integrity Bob Wade details how Peer Review and Compliance can work together. Hear how to train your team on Peer Review and Compliance issues, why Peer Review documents can be reviewed by other appropriate individuals in the hospital, how Peer Review issues can simultaneously be a False Claim, the use of the Midas reporting system, and a thrilling book recommendation from Bob. Learn more at CaptainIntegrity.com

Rare Qui Tam Jury False Claims Act Case: Learning Points Regarding FCA Cases Including Eli Lilly/Astellas Pharma Verdict Sep 14, 2022

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Jury trials under the False Claims Act (FCA) can produce very wild outcomes. In this episode, Captain Integrity Bob Wade breaks down what went down in the recent Eli Lilly/Astellas Pharma case. Hear why jury trials under the FCA are extremely rare, there are large jury verdicts, an effective compliance program can reduce or eliminate the risk of going to court, how big a return the government can receive, and how a mistake could be considered fraud. Learn more at CaptainIntegrity.com

False Claims Act Settlement Updates - Midyear 2022: The Dollars and the Issues Sep 06, 2022

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The False Claims Act (FCA) continues to be a huge weapon for the government. In this episode, Captain Integrity Bob Wade details the FCA settlements that have happened so far in 2022. Hear why there are still very large settlements that have occurred under the FCA, the knowledge requirement under the FCA is very broad, Corporate Integrity Agreements (CIAs) and Qui Tam Relators were front and center in many of these settlements, the basics of the FCA, and how much of the penalties are coming from the healthcare sector. Learn more at CaptainIntegrity.com

Legal and Operational Issues with Accountable Care Organizations/Value Based Arrangements: A Discussion with Kelly Conroy with Pinnacle Healthcare Consulting Aug 31, 2022

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Accountable Care Organizations (ACOs) are truly unique partnerships with the government. In this episode, Captain Integrity Bob Wade welcomes Kelly Conroy of Pinnacle Healthcare Consulting to chat the ins and outs of ACOs as they relate to the Stark Law. Hear why every primary care physician (PCP) should be in an ACO, almost every big commercial carrier has a shared savings component to it, ACOs are good for society, providers, and patients, how Kelly started the first ACO, and what she does in her job. Learn more at CaptainIntegrity.com

How to Respond to a Civil Investigative Demand (CID) Issued by the Department of Justice (DOJ) Aug 23, 2022

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How do you respond to a Civil Investigative Demand (CID) issued by the Department of Justice (DOJ)? In this episode, Captain Integrity Bob Wade details what to do and why you shouldn’t freak out. Hear why you should take the CID seriously and cooperate with the DOJ, involve competent outside legal counsel, review the documents prior to producing them to the DOJ, the types of documents the government demands, and Bob’s poem, “How to Respond to a CID.” Learn more at CaptainIntegrity.com

Office of Inspector General (OIG) Self-Disclosure Protocol: Different from the CMS SRDP Aug 16, 2022

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The Office of Inspector General (OIG) has a Self-Disclosure Protocol (SDP) as well, but it’s different than the Centers for Medicare and Medicaid Services Self-Referral Disclosure Protocol (CMS SRDP). In this episode, Captain Integrity Bob Wade shares how to disclose AKS, False Claims and potentially Stark Law violations through the OIG. Hear why the OIG SDP should not be used for strict Stark Law violations, what it can be used for, the multiplier they’ll target, differences vs. the CMS SRDP, and how long the statute of limitations applies. Learn more at CaptainIntegrity.com

How to Use the Self-Referral Disclosure Protocol (SRDP) to Voluntarily Report Stark Law Violations Aug 10, 2022

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If you discover a Stark Law violation, you can self-report it to the Centers for Medicare and Medicaid Services (CMS) through the Self-Referral Disclosure Protocol (SRDP). In this episode, Captain Integrity Bob Wade breaks down what to do when you find out there’s been a Stark Law violation. Hear why you should do your legal research before using the SRDP, reasonable settlements can be negotiated, you should use competent Stark Law legal counsel to assist you, what happens if you lay low and hope no one discovers the Stark Law violation, and possible resolutions outside of the SRDP. Learn more at CaptainIntegrity.com

Continuing Medical Education (CME): Fraud Issues and OIG Advisory Opinion 22-14 Aug 03, 2022

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Continuing Medical Education (CME) is needed, but you need to be careful how you hold these events. In this episode, Captain Integrity Bob Wade shares the positives and watchouts of CME under the Stark Law. Hear why CME is deemed to be remuneration and therefore must comply with the Anti-Kickback Statute (AKS) and Stark Law, Fair Market Value (FMV) for CME can be made by looking at overall expenses and dividing by the number of anticipated attendees, the best way to provide CME is under the Non-Monetary Compensation Exception or avail yourself of the Medical Staff Incidental Benefit Exception but also conform with the annual or per-benefit requirement, the opinion from the Office of Inspector General (OIG), and how much alcohol and entertainment there can be. Learn more at CaptainIntegrity.com

Compliance Experts and Monitors: What Are They and Why Are They Engaged? Jul 26, 2022

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Compliance experts and monitors can be valuable tools and resources in the world of the Stark Law. In this episode, Captain Integrity Bob Wade breaks down the duties and responsibilities of compliance experts and why they can be valuable for organizations. Hear who compliance monitors are generally appointed by, who pays for their services and expenses, why it’s a valuable effort for an organization to voluntarily engage their services, what life is like as a compliance expert, and an analogy to embedded journalists. Learn more at CaptainIntegrity.com

Selecting a Compliance Officer: Why, What, Who? Jul 20, 2022

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Being a compliance officer can be very challenging and rewarding. In this episode, Captain Integrity Bob Wade answers the questions he gets most often about compliance officers and the Stark Law. Hear why you need a compliance officer, what a compliance officer does, who should be a compliance officer, Bob’s experience as a compliance officer, and a fun analogy from Toy Story. Learn more at CaptainIntegrity.com

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