Financial relationships with physicians and vendors are receiving increased scrutiny in today’s regulatory environment. Provident Management Consulting’s (“Provident”) Physician & Vendor Arrangements solution helps build the policy and organizational structure needed to comply with Stark and Anti-Kickback Statute requirements. Our solution includes providing Independent Review Organization (IRO) and Corporate Integrity Agreement (CIA) services when needed.
OVERVIEW
- Prepares providers for defending against the growing trend of Stark and AKS investigations.
- Assures that policies and protocols are in place prior to transactions with physicians and vendors.
- Evaluates effectiveness of compliance policies, structure, and workflow and provides a roadmap for improvement.
- Provides Independent Review Organization services when needed.
The federal Physician Self-Referral Law (Stark law) and Anti-Kickback Statute (AKS) impose liability and financial penalties on providers who fail to properly document and monitor their financial arrangements with physicians and vendors.
Nationally, there is a growing trend of Stark and AKS investigations and settlements. The trend reveals that problems occur at all stages of physician and vendor relationships: failure to properly review and document transactions, failure to monitor compliance with the terms of the relationship post-transaction, and failure to document changes in the relationship that have migrated out of compliance.
A COMPREHENSIVE APPROACH
Provident’s Physician & Vendor Arrangements expertise helps develop a compliance infrastructure by addressing whether clients have the proper policy and organizational structure in place prior to engaging in transactions that trigger these statutory requirements. We also address how well the structure performs in monitoring those transactions once they are in place.
The scope of our solution includes governance and oversight, as well as policies, procedures, and workflow. Interdisciplinary collaboration and communication are addressed, along with processes for tracking and reporting relevant data and transactions.
Fair Market Value
Exceptions and safe harbors under Stark and AKS rely on defensible documentation of Fair Market Value (FMV). Provident’s solution ensures that appropriate protocols are in place to determine when a FMV assessment is needed and what type of assessment is most appropriate to the situation. Provident provides FMV assessments when external review is warranted and assists with best practices for the use of internally driven FMV assessments.
Independent Review Organization
Stark and AKS settlements often require providers to enter a CIA, mandating training and review by an IRO. Provident has significant experience guiding providers through the settlement and CIA process, performing IRO readiness assessments and providing IRO services.
Financial Relationships Database
An effective database tracking all financial relationships with physicians and vendors is essential to maintaining Stark and AKS compliance. Such a database is often required during the CIA process. Our solution helps providers choose and implement a tracking database, including tools and dashboards to monitor the ongoing compliance of the relationship, document the approach to FMV, and track renewal dates of all arrangements and other key data points. Our IRO experience with the new CIA requirements for arrangements databases is unparalleled.