Optional_2023 Board Resources

information provided to OIG about certain practices within the health care industry. Most of the more recent alerts and bulletins have focused on financial relationships involving physicians. OIG has published guidance on a variety of topics, including: (a) Laboratory Payments to Referring Physicians (b) Physician-Owned Entities (c) Telemarketing by Durable Medical Equipment Companies (d) Rental of Office Space in Physicians’ Offices (e) Routine Waiver of Copayments or Deductibles under Medicare Part B (f) Hospital Incentives to Referring Physicians (g) Arrangements for the Provision of Clinical Laboratory Services (h) Home Health Fraud (i) Fraud and Abuse in the Provision of Medical Services in Nursing Facilities (j) Fraud and Abuse in Nursing Home Arrangements with Hospices (k) Fraud and Abuse in the Provision of Services in Nursing Facilities (l) Physician Liability for Certifications in the Provision of Medical Equipment and Supplies and Home Health Services (m) Pharmaceutical Manufacturer Copayment Coupons and Independent Charity Patient Assistance Programs (n) Joint Venture Relationships (o) The Effect of Exclusion OIG has also written compliance program guidance (CPG) documents relating to certain types of health care providers and suppliers, such as hospitals, nursing homes, and physicians. 11 The CPGs outline the seven elements of compliance programs and discuss both general fraud and abuse risk areas as well as specific risk areas for that provider or supplier type. OIG has also produced other compliance resources, such as guidance for boards of directors 12 and compliance program training. 13 ARTICLE 2 THE STARK LAW 2.1 Description of Statute . The Stark law 14 prohibits a physician from referring patients for designated health services (“DHS”) payable by Medicare to an entity with which the physician (or immediate family member) has a financial relationship. 15 Further, the Stark law prohibits the DHS entity from submitting such claims to Medicare. 16 (a) Referring Physician and Referrals . The ‘referring physician’ is the physician who (x) makes a referral, (y) directs another person or entity to make a referral, or (z)

11 https://oig.hhs.gov/compliance/compliance-guidance/index.asp 12 https://oig.hhs.gov/compliance/compliance-guidance/compliance-resource-material.asp 13 https://oig.hhs.gov/compliance/101/index.asp 14 42 U.S.C. § 1395nn. 15 42 U.S.C. § 1395nn(a)(1)(A).