AMARILLO, TX – The upcoming Medtrade (Oct 20-23, 2014 in Atlanta) has
an excellent line-up of speakers who will present programs addressing
the most important topics faced by DME suppliers today. Every issue of
Medtrade Monday, leading up to Medtrade, will highlight a Medtrade
How You Can Legally Structure Relationships with Physicians, Hospitals, and Other Referral Sources
The lifeblood of any successful business is innovative marketing
and building referral networks. However, unlike non-healthcare
industries, the federal government has set out a number of restrictive
guidelines that DME companies must follow.
Under the Medicare anti-kickback statute (42 U.S.C. § 1320a-7b),
it is a felony for a provider to knowingly or willfully offer or pay
any remuneration to induce a person to refer a person for the furnishing
or arranging for the furnishing of any item for which payment may be
made under a federal health care program, or the purchase or lease or
the recommendation of the purchase or lease of any item for which
payment may be made under a federal health care program.
The beneficiary inducement statute (42 U.S.C. § 1320a-7a (a)),
imposes civil monetary penalties upon a provider that offers or gives
remuneration to any Medicare beneficiary that the offeror knows, or
should know, is likely to influence the recipient to order an item for
which payment may be made under a federal or state health care program.
This statute does not prohibit the giving of incentives that are of
“nominal value.” The OIG defines “nominal value” as no more than $10.00
per item or $50.00 in the aggregate to any one beneficiary on an annual
basis. “Nominal value” is based on the retail purchase price of the
the telephone solicitation statute (42 U.S.C. § 1395m(a)(17)), a DME
supplier may not contact a Medicare beneficiary by telephone regarding
the furnishing of a covered item unless (i) the beneficiary has given
written permission for the contact, or (ii) a supplier has previously
provided the covered item to the beneficiary and the supplier is
contacting the beneficiary regarding the covered item, or (iii) if the
telephone contact is regarding the furnishing of the covered item other
than an item already furnished to the beneficiary, the supplier has
furnished at least one covered item to the beneficiary during the
preceding 15 months.
The Stark physician self-referral statute (42 U.S.C. § 1395nn))
provides that if a physician has a financial relationship with an entity
providing designated health services (“DHS”), then the physician may
not refer patients to the entity unless one of the statutory or
regulatory exceptions applies. Designated health services include (i)
durable medical equipment, (ii) parenteral and enteral nutrients, (iii)
prosthetics, orthotics and prosthetic devices and supplies, and (iv)
outpatient prescription drugs, among others.
Safe harbor regulations issued under the anti-kickback statute
provide “bright line” tests defining arrangements that do not violate
the statute. If a business arrangement clearly falls within a safe
harbor, then it is not violative of the anti-kickback statute. If the
arrangement does not clearly fall within a safe harbor, then it must be
examined in light of the anti-kickback statute and related court
decisions to determine if it violates the statute.
A provider may submit to the OIG a request for an advisory
opinion concerning a business arrangement that the provider has entered
into or wishes to enter into in the future. In response, the OIG will
issue an advisory opinion concerning whether or not there is likelihood
that the arrangement will implicate the anti-kickback statute.
The OIG publishes Special Fraud Alerts and Special Advisory
Bulletins that discuss business arrangements that the OIG believes may
be abusive, and educate providers concerning fraudulent and/or abusive
All states have enacted statutes prohibiting kickbacks, fee
splitting, patient brokering, or self-referrals. Some state statutes
apply only when the payor is a state health care program, while other
statutes apply regardless of the identity of the payor.
This Medtrade program will discuss the legal parameters that
must be followed when entering into joint ventures and arrangements with
referral sources. Specific examples include medical director
agreements, employee liaisons, preferred provider agreements, and
Attendees at this program will:
1) Learn about the federal statutes and regulations governing
joint ventures, service agreements, and other arrangements with referral
2) Learn how to properly structure arrangements with referral sources.
3) Learn about the legal pitfalls in setting up arrangements, and how to avoid these pitfalls.
On Monday, October 20, 2014, Elizabeth H. Jepson (pictured), JD (Health Care Group, Brown & Fortunato PC) will present an in-depth program entitled How You Can Legally Structure Relationships with Physicians, Hospitals, and Other Referral Sources.
Providers who wish to register for Medtrade should CLICK HERE.
• The full link for registration is http://registration.experientevent.com/showmth141/default.aspx?flowcode=att
• Pricing for events can be found at http://medtrade.com/attendee/pricing.shtml
Exhibitors have already bought 95% of the floor space at the
Georgia World Congress Center in anticipation of what could be the most
important Medtrade in the event’s long history. For a complete list of
exhibitors and/or additional information about the show, visit www.medtrade.com.