Optional_2023 Board Resources

(i) (ii)

Rental of office space

Rental of equipment (iii) Bona fide employment (iv) Personal service arrangements (v) Physician recruitment (vi) Isolated transactions (vii) Certain arrangements that are "unrelated" to DHS (viii) Group practice arrangements with a hospital (ix) Payments by a physician (x) Charitable donations by a physician (xi) Non-monetary compensation up to $300 (currently $398 as inflation adjusted) (xii) Fair market value compensation (xiii) Medical staff incidental benefits (xiv) Risk-sharing arrangements (xv) Compliance training (xvi) Indirect compensation arrangements (xvii) Referral services (xviii) Obstetrical malpractice insurance subsidies (xix) Professional courtesy (xx) Retention payments in underserved areas (xxi) Community-wide health information systems (xxii) Electronic prescribing items and services (xxiii) Electronic health records items and services (xxiv) Assistance to compensate a non-physician practitioner (xxv) Timeshare arrangements ARTICLE 3 FALSE CLAIMS ACT

(a) Description of Statute . The False Claims Act (FCA) 29 prohibits knowingly presenting, or causing to be presented, a claim to the government that is false or fraudulent. 30 A claim may be pursued by the government as false or fraudulent if it includes (a) an item or service not medically necessary or involving “worthless” care, (b) an item or service billed that is different from the item or service provided, (c) duplicate or upcoded billing, or (d) claims that are tainted by non-compliance with AKS or the Stark law, among other things. Other common FCA claims include knowingly making or using, or causing to be made or used, a false record or statement material to an obligation to pay the government or knowingly concealing or improperly avoiding or decreasing an obligation to pay or transmit money or property to the government. The FCA's mens rea standard requires proof of actual knowledge, deliberate ignorance, or reckless disregard. 31

29 31 U.S.C. §§ 3729 – 3733. 30 31 U.S.C. §§ 3729(a)(1)(A) and 3729(a)(1)(B). 31 31 U.S.C. § 3729(b).