Issue link: https://beckershealthcare.uberflip.com/i/1187260
32 CODING & BILLING HHS may make changes to Stark Law, anti-kickback rules: 5 details By Laura Dyrda H HS may make changes to the Stark Law and Anti-Kickback Statute that are intended to make it easier for healthcare providers to collaborate on value- based care arrangements. Five things to know: 1. Under the proposed new rule issued by CMS, Stark Law would include value-based exceptions to acknowledge that the incen- tives for value-based care are different from volume-based care. e proposal includes safeguards to protect against overutilization, among other potential issues, but would give physicians and healthcare providers more flexibility. 2. e proposal also would change the Feder- al Anti-Kickback Statute to address concerns that the law, along with the Civil Monetary Penalties Law, limit healthcare provider co- ordination. e changes would allow provid- ers to be more flexible to innovation in care coordination, including through outcomes- based payment arrangements. 3. e proposed updates offer specific safe harbors for value-based arrangements that make it easier for healthcare providers, in- cluding physicians, to comply with the law. 4. e HHS announcement of proposed updates outlined situations that are currently roadblocks to care coordination that may be removed if the proposal is finalized. ose scenarios include allowing hospitals and physicians to work together to innovate in post-discharge care coordination; physi- cians providing patients with free pillboxes; patient data sharing between specialty and primary care physicians; and allowing hospitals to provide cybersecurity support to nearby providers. 5. e proposed rule also touches on al- lowing providers to give end-stage kidney disease patients technology to monitor their health. n Surgeon ordered to pay $4.25M to resolve kickback & false billing claims By Rachel Popa A Pennsylvania surgeon agreed to pay $4.25 million to resolve claims that he received kickbacks from two hospitals operated by Health Management Associates in Lancaster. Glenn A. Kline, DO, a general surgeon, allegedly was paid more than the average salary for general surgeons for referring patients to the hospital operator's two hos- pitals in Lancaster, as the operator competed with other institutions in the area. Dr. Kline's practice, Community Surgical Associates, also allegedly received kickbacks for referring patients to the operator's hospitals, which then billed federal healthcare programs for the patients' surgeries. "Our resolution of this matter and the significant recovery we have obtained from this physician show once again that no matter how complex the fraud scheme is, we will find it, stop it and punish it," said First Assistant U.S. Attor- ney Jennifer Williams. "The alleged improper physician inducements that Dr. Kline demanded and received are a form of 'pay to play' business practice that could compro- mise professional judgment." The case is related to a larger investigation in which Health Management Associates agreed to pay $260 million to the U.S. government to settle claims alleging fraudulent billing practices. n 11 physicians charged in federal opioid bust in Appalachia region By Rachel Popa E leven physicians were charged Sept. 24, in connec- tion with a U.S. Justice Department drug bust tar- geting opioid pill mills in the Appalachian region. The charges follow earlier arrests in April in which 53 medical professionals in 11 federal districts were charged with distributing more than 23 million pills illegally. Three details to know: 1. Four physicians were charged in the Southern District of Ohio with healthcare fraud and controlled substance diversion, including Troy Balgo, DO, the elected Belmont County coroner and owner of two medical clinics. The other three physicians charged include George Griffin, MD, with 20 counts of distribution of controlled substanc- es, Thomas Romano, MD, with 20 counts of diversion of controlled substances and Freeda Flynn, MD, with eight counts of distribution of controlled substances and one count of healthcare fraud. 2. In the Southern District of West Virginia, Sriramloo Kesari, MD, Ricky Houdersheldt, MD, and Michael Sh- ramowiat, MD, were charged with distributing controlled substances without a legitimate medical purpose. 3. Frank McNeil, MD, and Samuel Mcgaha, MD, were both charged with unlawful distribution of controlled substanc- es in the Eastern District of Tennessee. n