Stark Integrity

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What happens when something looks like fraud, but when you look at it closely enough, it’s not? In this episode, Captain Integrity Bob Wade dives into what happened in United States ex rel. Kyer v. Thomas Health System, Inc. as it relates to the Stark Law, the Anti-Kickback Statute (AKS), and the limits of qui tam litigation. Hear why high compensation does not equal fraud, why the correlation between a referral into a hospital and a physician receiving productivity compensation does not create a Stark Law violation, the question you should continue to ask when it comes to fraud, the key quote from the case, and how to know when fraud is just a mirage. Learn more at https://wadehealthlaw.com/

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This Halloween Special will serve as a survival guide for healthcare leaders. In this special Halloween episode, Captain Integrity Bob Wade shares his original poem, “The Compliance Officer and the Four Frights.” Hear the most frightening things in compliance, how to keep a reliable inventory of physician financial arrangements, the key agreement terms to track, how to make compliance part of the business conversation, and why compliance is not the department of NO. Learn more at https://wadehealthlaw.com/

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Silence. In this episode, Captain Integrity Bob Wade explains why that is the most dangerous sound in healthcare compliance. Hear why silence is data, how non-retaliation is a compliance control requirement, what the board’s job is when it comes to healthcare compliance, the earliest warning system in healthcare compliance, and the top reasons employees go quiet. Learn more at https://wadehealthlaw.com/

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Prevention really helps avoid much bigger problems down the road. In this episode, Captain Integrity Bob Wade explores the False Claims Act (FCA) with an international spin with Nelson Mullins Partner Christina Lehm. Hear why you should follow the government money, how to take internal concerns seriously and act early, how to treat litigation readiness as part of your business strategy, what international companies should be thinking about in terms of the False Claims Act as they enter the US market, and a bit of bar trivia on Oktoberfest. Learn more at https://wadehealthlaw.com/

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A new chapter: Wade Health Law. But, the same compass. In this episode, Captain Integrity Bob Wade introduces his new law firm, Wade Health Law. Hear why he’s starting his own law firm, 4 stories that have shaped his personal life & professional career, the most important lessons he’s learned in life & healthcare law, why change is inevitable, and what to expect in future episodes of Stark Integrity. Learn more at https://wadehealthlaw.com/

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We’re not talking about conversion factors as they relate to the 2027 Medicare Physician Fee Schedule (MPFS) and proposed rules. In this episode, Captain Integrity Bob Wade focuses primarily on how the 2027 MPFS may impact physician compensation and Fair Market Value (FMV) in the future. Hear why the 2027 MPFS means a lot more with respect to physician compensation, how the Centers for Medicare & Medicaid Services (CMS) is beginning to challenge certain areas, why the 2027 MPFS is increasingly about why providers get paid, the most surprising aspects of the 2027 MPFS, and an analogy for Christmas morning. Learn more at https://wadehealthlaw.com/

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There are 3 primary tests under the Stark Law: Fair Market Value (FMV), the Volume or Value standard, and Commercial Reasonableness (CR). In this episode, Captain Integrity Bob Wade dives deep into the Commercial Reasonableness standard. Hear why Commercial Reasonableness is fundamentally about a legitimate business purpose, the right questions to ask in terms of Commercial Reasonableness, why physician arrangements should be judged like a fire station, the biggest myth in healthcare compliance, and a David Letterman Top Ten List for Commercial Reasonableness. Learn more at https://wadehealthlaw.com/

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In the 2027 Physician Fee Schedule, CMS (Centers for Medicare & Medicaid Services) is proposing modifications for procedures and E&M services (Evaluation & Management) performed on the same day. In this episode, Captain Integrity Bob Wade describes what is being proposed as it relates to the Stark Law. Hear what is not going away, why the proposal is a payment methodology proposal, how there’s still time for advocacy to take place, several medical & non-medical examples, and Captain Integrity’s famous air quotes. Learn more at https://wadehealthlaw.com/

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Having someone who is accountable is essential for AI governance. In this episode, Captain Integrity Bob Wade discusses implementing & monitoring AI responsibly as it relates to the Stark Law with Arvita Tripati, Founder & Principal at Vahana Labs. Hear why buying technology does not outsource the accountability, why you need to ask every vendor when the tool was last validated, why the goal is not zero AI risk, a Netflix analogy around AI governance, and “The Compliance Bot” poem from Captain Integrity. Learn more at https://wadehealthlaw.com/

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Compliance committees can either be a well-oiled engine in a Lamborghini, or an engine being held up by an engine hoist in need of repair. In this episode, Captain Integrity Bob Wade shares how to run and participate in a compliance committee meeting that actually matters. Hear why a compliance committee should ask questions, how to focus on the fire instead of the smoke, why every compliance committee meeting should end with ownership, a Stark Law example of a compliance committee meeting agenda, and a fitting David Letterman Top Ten List. Learn more at https://wadehealthlaw.com/

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Why are private equity, physician groups, and the Stark Law like insects heading to a bug zapper? In this episode, Captain Integrity Bob Wade explains why. Hear why ownership changes do not eliminate Stark Law risk, why compensation redesign deserves careful attention, why documentation is your best defense, the mother of all definitions, and the research behind insects being attracted to light bulbs. Learn more at https://wadehealthlaw.com/

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You can now experience Stark Integrity in 2 ways: the podcast AND the blogs. In this episode, Captain Integrity Bob Wade introduces the Stark Integrity Podcast Blogs, where you can enjoy each episode as 1 conversation, with 2 experiences. Hear what to expect with the new Stark Integrity website, how your favorite Stark Integrity topics & episodes are now searchable, the goal of Stark Integrity from the very beginning, how to use the new site as a research tool, and how your feedback helped shape the new site. Check out the new site at https://wadehealthlaw.com/

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In a recent episode of Stark Integrity, Captain Integrity Bob Wade made an incorrect statement regarding Erlanger Health and a Stark Law case. In this brief update, he sets the record straight. Learn more at https://captainintegrity.com/

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Lean in wherever you have quick wins. In this episode, Captain Integrity Bob Wade talks using AI in physician contracting & payment as they relate to the Stark Law with Scott Lowry, Founder of StarkWatch. Hear how to quickly assess where your organization’s at with its Stark Law compliance program, how to aim for advancement instead of program perfection, why you should use inexpensive AI solutions to perform reviews & monitoring, some of the use cases for StarkWatch, and a bit of nostalgia for old school, offline resources. Learn more at https://captainintegrity.com/

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Training goes a long way when it comes to informed consent. In Part 3 of this 3-part episode, Captain Integrity Bob Wade talks informed consent, decision-making capacity, and surrogates as they relate to the Stark Law with Attorney Rachel Rose. Hear why you need to document the decision-making capacity, how to make sure AI use is properly disclosed, why policies & procedures play a huge role, how AI is changing the healthcare world, and how surrogates work. Learn more at https://captainintegrity.com/

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The more checks and balances an organization has along the way, the greater the protection for both the patients & the providers. In Part 2 of this 3-part episode, Captain Integrity Bob Wade talks informed consent, decision-making capacity, and surrogates as they relate to the Stark Law with Attorney Rachel Rose. Hear how decision-making capacity & inadequate informed consent lead to legal liability, considerations when it comes to anesthesia, personal anesthesia stories from Bob & Rachel, the best practices organizations can take to uphold patient autonomy, and notable high-profile cases involving sexual assault. Learn more at https://captainintegrity.com/

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The patent’s right to autonomy is one of the core principles of the patient-provider relationship. In Part 1 of this 3-part episode, Captain Integrity Bob Wade talks informed consent, decision-making capacity, and surrogates as they relate to the Stark Law with Attorney Rachel Rose. Hear the recent cases where informed consent & decision-making capacity were relevant, the difference between decision-making capacity & informed consent, why having the piece of paper signed doesn’t necessarily mean informed consent, how providers & patients can protect themselves, and what you should think through as a patient before moving forward with anything. Learn more at https://captainintegrity.com/

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You should be able to duct tape your mouth & hands and give your documentation to the payer, and they should still be able to generally understand what happened. In Part 2 of this 2-part episode, Captain Integrity Bob Wade continues his discussion on holistic audits and synchronizing professional & facility reviews under the Stark Law with Kelly Loya & Bruce Truitt of Pinnacle Enterprise. Hear how to consider all entities of the claim, when to consider unified sampling, how to help payers, how the 60-day overpayment rule works, and how to handle the discussion that the file is closed. Learn more at https://captainintegrity.com/

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You can’t audit the whole ocean. In Part 1 of this 2-part episode, Captain Integrity Bob Wade discusses holistic audits and synchronizing professional & facility reviews under the Stark Law with Kelly Loya & Bruce Truitt of Pinnacle Enterprise. Hear what holistic audits are, the different types of reviews, the benefits of sampling a patient encounter, how to maintain an unbiased sample, and the parable of the blind men and an elephant. Learn more at https://captainintegrity.com/

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There is indeed a return on investment (ROI) for an effective compliance program. In this episode, Captain Integrity Bob Wade quantifies that ROI as it relates to the Stark Law. Hear why the ROI can be 2x-5x what the organization is investing, how the cost for non-compliance is 2x-3x higher, why you shouldn’t look at the compliance program as just a cost center, examples of compliance program ROI calculations, and your ROI if you would have invested in Apple & Disney in the early days. Learn more at https://captainintegrity.com/