Stark Integrity

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There have been some surprising and some not-so-surprising settlements under the False Claims Act (FCA) so far in 2023. In this episode, Captain Integrity Bob Wade details the most interesting decisions. Hear why the qui tam bar is still extremely active, there appears to be a great focus on the specialty of ophthalmology, Fair Market Value (FMV) and Stark Law issues are still high on the list, the most notable cases, and one that has a shock factor. Learn more at CaptainIntegrity.com

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There’s a lot to unpack from all that happened in 2020. In this episode, Captain Integrity Bob Wade dives into the fallout from the CARES Act with Bart Daniel, Partner at Nelson Mullins. Hear what the CARES Act is, the landscape of fraud relating to the CARES Act, why the PPP (Paycheck Protection Program) was abused so commonly, how the government is pursuing those who abused these programs, and who the whistleblower typically is. Learn more at CaptainIntegrity.com

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Call arrangements are a hot topic for many entities in the healthcare space. In this episode, Captain Integrity Bob Wade discusses the details with Ashley Graver, Vice President of Coker Group. Hear why organizations should carefully consider the need for each call coverage arrangement, organizations should approach payment for calls in an equitable manner, why you shouldn’t set it and forget it, the type of market data available, and a classic “beeper” reference. Learn more at CaptainIntegrity.com

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Civil and criminal investigations have become a huge focus in the healthcare industry. In this episode, Captain Integrity Bob Wade discusses why that’s the case with Bart Daniel, Partner at Nelson Mullins. Hear when you should retain experienced white collar healthcare counsel immediately, how to determine the nature and scope of the investigation, why you should cease any borderline conduct immediately, how an investigation begins, and “The Parade of Horribles.” Learn more at CaptainIntegrity.com

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There are several mistakes that can be made when conducting a Fair Market Value (FMV) review. In this episode, Captain Integrity Bob Wade dives into these mistakes and how to prevent them. Hear why FMV opinions are qualified, you should focus on personally performed productivity, how to make sure you understand the full-time equivalency (FTE) of the physician you’re reviewing, the “Dirty Dozen” of FMV analysis mistakes, and how wRVUs fit into the mix. Learn more at CaptainIntegrity.com

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How do time-share lease arrangements work in the healthcare world? In this episode, Captain Integrity Bob Wade dives into the details with Ron Young, President and Owner of The Advisory Group. Hear why consistency in your methodology is critical, the monitoring of the space needs to be documented, when to think like a patient, why a hospital or medical provider would time-share real estate, and the hotel room analogy. Learn more at CaptainIntegrity.com

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There is a legal storm brewing over the definition of remuneration. In this episode, Captain Integrity Bob Wade breaks down all the factors under the Stark Law. Hear why it needs to meet a safe harbor, it needs to meet Fair Market Value (FMV) and Commercial Reasonableness (CR), why you shouldn’t make the connection between the financial arrangement and the inducement for referrals, notable cases to discuss, and how the transfer of value plays into things. Learn more at CaptainIntegrity.com

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Clear, concise, easily understood. In this episode, Captain Integrity Bob Wade discusses the Supreme Court’s ruling on the False Claims Act (FCA) with Bart Daniel, Partner at Nelson Mullins. Hear why no after-the-fact justification can be used to knowingly file a false claim, the subjective standard is the standard, the court made it clear the False Claims Act is rooted in common law fraud, the 3 definitions of knowledge under the False Claims Act, and what drew a Paul Harvey reference from Bart. Learn more at CaptainIntegrity.com

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Big changes are coming. In this episode, Captain Integrity Bob Wade continues his discussion of split/shared billing for Advanced Practice Providers (APPs) with Jodi Nayoski and Andrea Ferrari of Pinnacle Healthcare Consulting. Hear how the crediting of wRVUs will be affected, the impact the change will have on measures of productivity, why you should consider changes to provider compensation plans, what it means for compensation for NPPs, and how Fair Market Value (FMV) plays into things. Learn more at CaptainIntegrity.com

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It’s going to get confusing. In this episode, Captain Integrity Bob Wade talks split/shared billing for Advanced Practice Providers (APPs) with Jodi Nayoski and Andrea Ferrari of Pinnacle Healthcare Consulting. Hear when the new guidelines go into effect, why the documentation must be substantive, how to correctly identify the date of service, the difference between APPs and NPPs, and what this all means for split/shared visits. Learn more at CaptainIntegrity.com