Apr 18 2018

How to Put Your Finger on the Scale of Patient Satisfaction – Medical Group Minute

Patient satisfaction surveys are becoming a real part of reimbursement, driving a significant percentage of money.

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Mark F. Weiss

Apr 17 2018

The Timing Is Never Right, So Start Now – Success In Motion Series

Ride along with Mark while he discusses why “the timing is never right” simply means that you should get started now. After all, the timing will never be right.

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Mark F. Weiss

Apr 16 2018

$2.6 Billion Collected By Feds From Compliance Cheats. ROI Makes Warren Buffet Look Like An Amateur.

Even Warren Buffet can’t get you this return: 420% over three years.

And, it’s 100% leveraged. OPM.  

Well, not OPM as in “other people’s money,” but OPM as in “our public money.”

That’s the return on investment that the Feds generated from 2015 to 2017 as a result of coordinated Department of Health and Human Services and Department of Justice healthcare anti-fraud operations.

In total, their efforts returned $2.6 billion.

And, as icing on the compliance cake, the Feds also obtained some non-monetary rewards (especially for those who count convictions as wins): In 2017 alone, the DOJ opened 967 new criminal healthcare fraud investigations, leading to criminal charges against 720 defendants. 639 defendants were convicted of health care fraud-related crimes during the year.

But that’s just the DOJ. The joint DHHS/DOJ Medicare Fraud Strike Force brought charges against an additional 478 defendants, negotiated 290 guilty pleas and obtained convictions against another 40 defendants. 305 individuals went off to prison for an average sentence of more than 50 months behind bars.

If you previously wondered why we have laws such as the federal Anti-Kickback Statute and Stark, and questioned whether they are based on fact or fiction, you might as well give up your queries. After all, it’s a big business. No, that’s incorrect. It’s a big bureaucracy.

In the vernacular, them’s the facts. So, we have to deal with them. 

Compliance is not just a punch card list. It’s not just a plan. It’s not just a program. It’s a target, the one that’s painted on your back. There’s hotlines and whistleblowers and strike forces and postal inspectors and Assistant U.S. Attorneys looking to make their stripes. You have to assume that they’re all looking at you.

There’s baseline self-inspections, there are red teams to privately ferret out your weaknesses, there’s active compliance versus passive time wasting. If you need help, get in touch fast.
 
Get moving. Now.

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Mark F. Weiss

www.advisorylawgroup.com

 

Apr 12 2018

What If They Had Begun to Think About Their Future When It Was Still in Their Past? – Podcast

The medical group that I was going to see was under pressure. One of its former members had jumped ship and aligned with a competitor. The hospital issued an RFP. The competitor became the golden haired group.

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Mark F. Weiss

Play

Apr 11 2018

Avoid Shiny Objects In Healthcare Deals – Medical Group Minute

Ah, the shiny object, the more or less instant gratification. The $10 million in your pocket.

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Mark F. Weiss

Apr 10 2018

Don’t Step In Unintended Consequences – Success In Motion Series

Sit back while Mark discusses the fact that you need to be careful that you aren’t creating problems with a current deal by entering into what appears to be a benign amendment or even a simple deal with a third party.

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Mark F. Weiss

Apr 09 2018

CHS Loses $2 Billion. CEO Gets Raise.

This is a short update on the lack of skin in the game by hospital executives. In other words, very little downside risk for their failures, but very great upsides.

Take a look at my April 2, 2018 blog post, What’s The Downside Risk for Hospital Executives?  Subsequently, Community Health Systems, known in the healthcare community as CHS, announced the 2017 compensation for its CEO, Wayne Smith, whom I mentioned in the blog post.

CHS lost approximately $2 billion dollars in 2017 on revenues of $3.1 billion.

Was Mr. Smith laid off? Was he fired? No, Mr. Smith’s total 2017 comp increased over the prior year (in which the company lost “ONLY” $220 million on revenue of $4.5 billion).

Revenue goes down by 1.4 billion . . . Losses go up by a factor of almost 10. Mr. Smith’s income goes up to near $5 million for the year.

Talk about no skin in the game. Not only does he not suffer for the horrible financial results, he’s rewarded as if they didn’t happen.

Pitch that to your employer or fellow shareholders and see if they’ll go for the plan.

Apr 09 2018

Uncompensated Medical Directorship Leads to $3.2 Million False Claims Act Settlement

You may have seen their websites: Anesthesia “practice management companies” that advertise “no stipends!” to obtain facility contracts.

Or, you may have seen the RPFs, usually drafted by “consultants” or “management companies”  (and others specializing in perhaps unknowingly committing federal crimes) who promise the surgeon-owners of ASCs that they’ll get anesthesia groups to provide a plethora of coverage and directorship services for free.

Oops. Nothing just became $3.2 million. Plus legal fees. Plus the continued risk of being criminally prosecuted.

Yes, the type of stupid compliance mistake underlying these idiots’ thinking just led to a $3.2 million civil settlement of a False Claims Act (i.e., whistleblower) suit brought against (among others) an orthopedic surgery practice, Georgia Bone & Joint (“GBJ”) and its related surgery center, Southern Bone & Joint a/k/a Summit Orthopaedic Surgery Center (“Summit Surgery Center”), as well as against CRNA David LaGuardia (“LaGuardia”) and anesthesia entities Southern Crescent Anesthesiology, PC (“SCA”) and Sentry Anesthesia Management, LLC (“Sentry”).

The suit was initially brought by Sharon Kopko, the former practice/facility administrator for both GBJ and Summit Surgery Center.  Upon investigation by the U.S. Department of Health & Human Services Office of Inspector General, the FBI, and the U.S. Postal Service Office of Inspector General, the federal government took up the prosecution of the case.

From the settlement announcement of the U.S. Attorney for the Northern District of Georgia, the allegations against the defendants apparently grew from those originally contained in Ms. Kopko’s complaint to include  that LaGuardia, Sentry, and SCA provided a free medical director to Summit Surgery Center  in order to induce it to choose to perform more procedures at the surgery center rather than in the GBJ office.

In the words of the U.S. Attorney, “Kickbacks should never play a role in medical decision-making. It is critical to our health care system that patients seeking health care know that their providers’ recommendations are based on what is in the patient’s best interests and not influenced by illegal kickbacks or arrangements.”

Stay tuned. It’s yet to be seen who’ll now be criminally prosecuted.

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Mark F. Weiss

www.advisorylawgroup.com

 

Apr 05 2018

Kickback Disguise Schemes: Oh, What A Tangled Web We Weave – Podcast

“Psst! Send me some referrals. I can’t pay you directly, so I’ll pay your spouse.”

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Mark F. Weiss

Play

Apr 04 2018

But Does It Work in the Real World? Second Order Thinking and Perfect Legal Structure – Medical Group Minute

I recently attended a continuing legal education seminar. From a purely legal standpoint, the models made sense. However, from the practical standpoint, one apparently lost on the presenter, the structures were unfinanceable.

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Mark F. Weiss