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In This Issue

When the Government Comes Knocking: This article will provide an outline of some of the most significant points for hospitals to use when confronted with a formal government investigation under the Criminal or Civil False Claims Act. As noted below, you should refer to your compliance program, which should provide more detailed guidance in these situations. Audits or reviews by government health care programs or state Medicaid program contractors require a less immediate response by the hospital.

Proposed Changes To Stark Rule Would Create New Hospital Exceptions and Lessen Burden of Self-disclosures: In a development that is limited in scope but still welcomed by hospitals, the proposed 2016 Physician Fee Schedule proposes a number of new exceptions to the physician self-referral or Stark law and other refinements that should lessen the burden of technical Stark violations leading to self-disclosure. The proposed rule would create new exceptions under the Stark law for hospital payments to physicians to recruit mid-level practitioners and timeshare arrangements with physicians.

Access To Employee Benefit Records – Take Action Now to Avoid Issues Later: In today’s world, many records relating to employee benefits reside with the vendors who administer those employee benefit plans (including forms mandated by statute and regulations, participant phone call center recordings and notes, benefit elections, benefit calculations, compensation data, and other historical data). Employers are sometimes surprised to find that their vendors (or former vendors) are not able to produce the records they need in order to respond to a participant or government audit or inquiry or that those records and forms are insufficient to meet compliance standards.

Hospital Compliance Program Overview: In the constantly evolving climate of health care enforcement, maintaining a comprehensive and effective internal compliance program has taken on added significance, especially in the past few years. While detailed coverage of the elements, drafting, and implementation of a hospital compliance program cannot be provided by this article, this overview serves as a broad summary of what hospital leadership and compliance teams should be focusing on as we see the advent of mandatory compliance programs. The resources referenced in this article, along with the assistance of experienced legal counsel, should assist your facility in its review and development of a robust compliance program and related compliance plans, policies, procedures, training, and internal compliance audit functions.

Conscience Clauses for Health Care Providers: There has been a lot of news lately about a person’s right to decline to provide a service to another for reasons of conscience. For example, after the U.S. Supreme Court decision regarding marriage equality, the N.C. General Assembly passed legislation granting magistrates the right to decline to perform marriages for same sex couples. Do health care providers have any similar rights of conscience in North Carolina? In several discrete circumstances, the answer is yes.

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