The Stark Law provides that if a hospital has a financial relationship with a physician, the relationship must fit within a specific exception in the law. The Anti-Kickback Statute prohibits paying or receiving remuneration in return for referrals of business paid for by Medicare or Medicaid.
Because “financial relationship” and “remuneration” are so broadly defined, any arrangement where anything of value passes from a hospital to a physician should be carefully scrutinized. This would include expense reimbursement, indemnification, or covering expenses (including airfare, hotel and meals at seminars) commonly provided to medical staff leaders, when travelling to and attending conferences in person at the request of the hospital.
If the physician in question is an employee of the hospital or health system, there should be no problem with the physician’s employer paying seminar travel expenses for attendance, either in-person, virtual or on-demand. The Anti-Kickback Statute does not apply to bona fide employment contracts, and the Stark Law exception for employment arrangements would permit this.
If the physician is not employed, paying for the physician’s seminar attendance can be addressed in a number of ways. With respect to in-person attendance at a seminar, the Stark law and Anti-Kickback Statute allow personal service arrangements. Those arrangements fit within the exception if the expense and any compensation is fair market value, commercially reasonable and the arrangement is committed to writing. If the physician is not employed, a written contract in the form of a letter agreement is essential when a physician leader is asked to attend a conference outside of the hospital’s service area . Here is a link to a sample letter agreement that you may want to consider using.
There is also a Stark exception for “Compliance Training” which covers training held in the local community where the content deals with laws, regulations or rules governing the conduct of the trainee. Since HortySpringer’s educational offerings focus on that, and because the virtual seminars can be presented at the hospital or on-line at the physician’s convenience, we believe that the compliance training exception applies.
Likewise, if the physician is receiving the training to enhance his or her ability to carry out duties on behalf of the hospital as a medical staff leader, the Anti-Kickback Statute would not be implicated because there would be no quid pro quo for or expectation of referrals for the physician.
Please be advised that this information and the sample letter agreement are not intended to be giving legal advice for specific cases or circumstances. No one should act or refrain from acting on the basis of this information presented at these seminars without seeking the appropriate legal advice on any particular facts and circumstances at issue from a lawyer practicing as permitted by applicable laws, regulations or rules of professional conduct. No attorney-client relationship is formed by relying on this information.