Fair Market Value in Hospital and Physician Transactions: Complying With Anti-Kickback and Self-Referral Laws

With an increasing focus on improvements in patient care, value-based reimbursement methodologies, bundled payments, costs management, and reduced third-party reimbursements, healthcare providers are exploring innovative ways to collaborate with physicians to deliver care. Healthcare providers are frequently using joint ventures, co-management arrangements, ACOs and other arrangements to achieve these goals.

Almost every healthcare-related transaction involves fair market value (FMV) issues. For example, parties often must ensure that payments to referral sources are consistent with FMV to satisfy applicable Stark and anti-kickback law exceptions.

Over the last several years, FMV determinations have become a focal point in many government investigations and litigation, with litigants at odds about the basis and appropriateness of FMV comparisons.

Healthcare associate Jake Harper and Hunter A. Wolfel, Manager at HealthCare Appraisers, will provide guidance on understanding the importance of FMV assessments in hospital-physician transactions as a way to ensure compliance with anti-kickback and self-referral laws.

The panel will review these and other key issues:

• What are the FMV requirements that must be met to comply with Stark and anti-kickback laws?
• What lessons can be learned from recent litigation in which FMV was challenged?
• What steps can counsel take to avoid common FMV pitfalls?