To provide guidance as to Rowan University School of Medicine's (RowanSOM) process of determining whether a transaction with a Potential Referral Source (as defined below) is made at fair market value in order to comply with Stark Law (42 U.S.C. § 1395nn ) and the Anti-kickback Statute (42 U.S.C. § 1320(a)-7b(b)).
Under the direction of the President, the Dean, General Counsel, and Chief Compliance and Privacy Officer are to ensure compliance with this policy. The deans and chief executive officers shall implement this policy.
This policy applies to all RowanSOM operating units, including but not limited to hospitals, physician practices and outpatient centers.
A. "Referral Source" - an actual source of health care business or referrals to RowanSOM, or between RowanSOM and a physician (or a physician's immediate family member (as defined at 42 CFR. 411.351) - include, but are not limited to, another Physician, hospitals, long-term acute care centers, nursing homes, clinics, physician group practices, therapists and other individuals and entities who are in a position to influence or make referrals.
B. "Focus Arrangement" - every arrangement that involves, directly or indirectly, the offer or payment of anything of value and is between RowanSOM and any actual source of health care business or referrals to RowanSOM, or is between RowanSOM and a physician (or a physician's immediate family member (as defined at 42 CFR 411.351) who makes a referral (as defined at 42 CFR. 1395nn(h)(5)) to RowanSOM for designated health services (as defined at 42 U.S.C. 1395nn(h)(6)).
C. "Immediate Family Member" - husband or wife; birth or adoptive parent, child or sibling; stepparent, stepchild, stepsibling; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law or sister-in-law; grandparent or grandchild; spouse of grandparent or grandchild.
D. "Physician" - a doctor of medicine or osteopathy, a doctor of dental medicine or dental surgery, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor.
E. "Potential Referral Sources" - physicians, hospitals, long-term acute care centers, nursing homes, clinics, physician group practices, therapists and other individuals and entities who are in a position to influence referrals.
A. Professional Services Agreements
B. 42 U.S.C. § 1395nn; 69 Fed. Reg. 16107 (March 26, 2004); 42 C. F. R. § 411.350 et. seq.
C. MGMA Academic Practice Compensation and Production Survey Report
D. MGMA Physician Compensation and Production Report
E. AAMC Survey of Resident/Fellow Stipends and Benefits
F. Sullivan Cotter Compensation and Productivity Surveys
G. Corporate Integrity Agreement Between the Office of Inspector General of the Department of Health and Human Services and the University of Medicine and Dentistry of New Jersey, September 25, 2009.
A. Any transaction with an Actual or Potential Referral Source is to be at fair market value. Whenever RowanSOM requires a fair market valuation in order to comply with Federal or State laws and regulations or with its own policies and procedures, no conflict of interest, such as the ability of one party to refer patients or other business to the other, may affect the terms of the transaction or the valuation.
B. The Office of Compliance and Corporate Integrity will educate responsible parties on the laws, regulations and policies regarding the need for fair market value determinations, will monitor and review agreements, will review the fair market value documentation attached to agreements and attest to the appropriateness and reasonableness of the methodology used by the business units as reflected in the documentation provided by the business units for the services rendered under such agreement and will assist the responsible dean or vice president with remediating such agreements when potential violations of this policy are detected.
A. Attachment 1, Procedure for Determining Fair Market Value
By Direction of the President:
Signature on file
RowanSOM Chief Compliance and Privacy Officer
A. Prior to executing any transaction with an Actual or Potential Referral Source, the relevant business unit must determine and secure appropriate supporting documentation that any compensation given or received in the transaction is at fair market value. At a minimum, the following considerations must be included in any fair market value analysis.
B. Fair Market Value Defined
C. Determination of the compensation under fair market principles will begin with a range of benchmark payments, as described below. The appropriate value to select from within the range for a given transaction depends on individual factors. For example, a physician with a considerable experience in an area or a historically documented high level of personal productivity could receive compensation on the high end of the range. Similarly, where office space to be leased is in below standard condition for the market, the lease rate charged may be in the low end of the range.
D. Rental or Lease of Space or Equipment
E. Personal Service Agreements and Employment Agreements
F. If any transaction with a Potential Referral Source is a Focus Arrangement (as defined above), the Focus Arrangements Database Policy and Focus Arrangements Approval Procedure apply and must be followed.