Stark Integrity

Send us Fan Mail Use your superpowers in the field of compliance. In this episode, Captain Integrity Bob Wade talks value creation in the world of compliance with Jerry Shafran, Founder and Chief Executive Officer of YouCompli. Hear how to channel your inner salesperson, simplify, be an instigator of change, what sales and compliance have in common, and the reputation of compliance professionals....

Send us Fan Mail Can we really throw Fair Market Value (FMV) out the window? In this episode, Captain Integrity Bob Wade revisits Value-Based Arrangements with a special focus on mistakes that can be made. Hear why Value-Based Arrangements through the Safe Harbor and the Exception are a beautiful thing, it’s critical the governing body meet regularly and review the criteria, what happens if you do...

Send us Fan Mail Believe it or not, the Stark Law involves charitable contributions by physicians and immediate family members. In this episode, Captain Integrity Bob Wade explains the rules of charitable contributions as they relate to the Stark Law. Hear why remuneration plays a key role, charitable contributions cannot be solicited or offered by a physician who takes into account the volume or...

Send us Fan Mail Legal Independent Review Organizations (IRO) are usually required under Corporate Integrity Agreements when physician financial arrangements are involved in the settlement - but you don’t have to use a LIRO in only Corporate Integrity Agreements. In this episode, Captain Integrity Bob Wade breaks down the world of LIROs when it comes to the Stark Law. Hear why a LIRO has to be ind...

Send us Fan Mail Thorough documentation can go a long way under the Stark Law. In this episode, Captain Integrity Bob Wade continues to dive into the Medicaid-Stark Law pool - this time with special guest Andy Lenobel, Associate General Counsel at Nationwide Children’s Hospital. Hear why you need to show your work, follow your policy, learn to love the endless nature of compliance, Andy’s view fro...

Send us Fan Mail Does the federal Stark law apply to state Medicaid reimbursement? In this episode, Captain Integrity Bob Wade outlines why it doesn’t really matter - as he dives into the Medicaid-Stark Law pool. Hear why there’s still an argument whether hospitals violate the federal Stark Law when they submit Medicaid claims, many states still have their own Stark Law statutes and regulations, F...

Send us Fan Mail Determining where a physician’s conduct should be reviewed is a challenging subject. In this episode, Captain Integrity Bob Wade continues his breakdown of Peer Review and Compliance in relation to the Stark Law. Hear why quality can be both a Peer Review and a Compliance issue depending on the severity, fraud issues that impact billing are usually the exclusive domain of the Comp...

Send us Fan Mail 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 th...

Send us Fan Mail 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 th...

Send us Fan Mail 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 wer...

Send us Fan Mail 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 compon...

Send us Fan Mail 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 docum...

Send us Fan Mail 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...

Send us Fan Mail 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 c...

Send us Fan Mail 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 a...

Send us Fan Mail 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...

Send us Fan Mail 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. Lea...

Send us Fan Mail Time reports are important for compliance, Fair Market Value, commercial reasonableness, and cost reporting for physician administrative services. In this episode, Captain Integrity Bob Wade details why time reporting is so essential to Stark Law compliance. Hear why time studies are required for cost reporting purposes, to meet commercial reasonableness and Fair Market Value stan...

Send us Fan Mail Compensation pools are commercially reasonable but must be carefully assessed. In this episode, Captain Integrity Bob Wade shares a Stark Law analogy perfect for the summer pool season. Hear why the funding of pooled compensation must come from a defensible source, you cannot use pooled compensation to reward for referrals, attorney and compliance officer “lifeguards” should monit...

Send us Fan Mail K.I.S.S. applies to the Stark Law as well. In this episode, Captain Integrity Bob Wade explains how to “Keep it Simple, Stupid” when considering the Stark Law with your team and clients. Hear how to know your audience, understand what type of complexity you’re dealing with, make your analysis value-based, the impact of attorneys, and how to bring value to your client. Learn more a...

Send us Fan Mail Providers may be facing a significant workflow change. In this episode, Captain Integrity Bob Wade welcomes Amy Noecker and Zachary Hartsell from SullivanCotter to chat shared services performed by physicians and APPs (Advanced Practice Providers) under the Stark Law. Hear how to assess the current state of split/shared billing, evalue your current care team composition and respon...

Send us Fan Mail It takes two to tango in the Stark Law world. In this episode, Captain Integrity Bob Wade welcomes Marlan Wilbanks, Esq. to chat physician liability and qui tam cases under the Stark Law and Anti-Kickback Statute. Hear why the Fair Market Value (FMV) train runs both ways, you should be very, very wary of how you handle wRVU calculations in your hospital, free employees aren’t alwa...

Send us Fan Mail It’s time to consider some automation. In this episode, Captain Integrity Bob Wade welcomes Gail Peace of Ludi, Inc. to chat how healthcare technology can make things easier, quicker, and less expensive for your hospital. Hear why automation helps conquer the complex when it comes to the Stark Law, how to make things easier for your physicians, how costly the time you’re spending...

Send us Fan Mail The parties need to intend to enter into a financial arrangement for a violation under the Stark Law to occur. In this episode, Captain Integrity Bob Wade talks all things “intent” in relation to the Stark Law. Hear why the intent of both parties to enter into an arrangement needs to be made for the Stark Law to be implicated, parties must obtain payment of the value of the remune...

Send us Fan Mail Hospitals can financially induce non-physician practitioners to relocate - but be very careful. In this episode, Captain Integrity Bob Wade dives into non-physician practitioner recruitment under the Stark Law. Hear why the rules with respect to non-physician practitioners are very different, the financial incentive cannot exceed 50% of the compensation, signing bonus, and benefit...