Presenting a live 90-minute webinar with interactive Q&A Medical Office Leases: Navigating Stark Law, Anti-Kickback Statute, Operational Restrictions, and More Drafting to Address Reciprocal Easements, Ground Leases, HIPAA, ADA, and Environmental Issues Unique to Medical Office Use WEDNESDAY, APRIL 18, 2018 1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific Today’s faculty features: Allison Nelson, Partner, Akerman , Denver Ayman Rizkalla, Partner, Akerman , Washington, D.C. The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. Please refer to the instructions emailed to registrants for additional information. If you have any questions, please contact Customer Service at 1-800-926-7926 ext. 1 .
Tips for Optimal Quality FOR LIVE EVENT ONLY Sound Quality If you are listening via your computer speakers, please note that the quality of your sound will vary depending on the speed and quality of your internet connection. If the sound quality is not satisfactory, you may listen via the phone: dial 1-866-871-8924 and enter your PIN when prompted. Otherwise, please send us a chat or e-mail sound@straffordpub.com immediately so we can address the problem. If you dialed in and have any difficulties during the call, press *0 for assistance. Viewing Quality To maximize your screen, press the F11 key on your keyboard. To exit full screen, press the F11 key again.
Continuing Education Credits FOR LIVE EVENT ONLY In order for us to process your continuing education credit, you must confirm your participation in this webinar by completing and submitting the Attendance Affirmation/Evaluation after the webinar. A link to the Attendance Affirmation/Evaluation will be in the thank you email that you will receive immediately following the program. For additional information about continuing education, call us at 1-800-926-7926 ext. 2.
Program Materials FOR LIVE EVENT ONLY If you have not printed the conference materials for this program, please complete the following steps: • Click on the ^ symbol next to “Conference Materials” in the middle of the left - hand column on your screen. • Click on the tab labeled “Handouts” that appears, and there you will see a PDF of the slides for today's program. • Double click on the PDF and a separate page will open. • Print the slides by clicking on the printer icon.
Medical Office Leasing: Navigating Stark, Anti-kickback and Other Concerns Ayman Rizkalla Allison Nelson April 18, 2018
Medical Office Leasing – Introduction
Introduction • How are medical leases different? • on-campus vs. off-campus • ground leases, master leases, and timeshares • longer terms • operational issues • regulatory issues • tenant improvement allowances 7
Overview • Today’s Discussion • medical leasing trends – distribution and decentralization • healthcare regulatory requirements • other medical leasing considerations 8
Medical Office Leasing – Trends
Medical Lease Trends Urgent Care Centers • Rise in UCCs continue (adding 300-400 p/y) • shortage in primary care physicians • hospital marketing strategy • convenience • economical • larger UCCs acquiring smaller outfits • UCC Models/Successes • 95% patient satisfaction rates • access • reduces lengths of stays at hospitals/rehab facilities/long term care • $4.4B savings in hospital visits 10
Medical Lease Trends Urgent Care Centers • Locations • Investors • shopping centers 34.1% • shift from physician owned to hospital owned • freestanding 33.2% • physician JV with investors • mixed use 13.6% • private equity (consolidating back • medical office buildings 19.1% office & utilizing direct marketing) 11
Medical Lease Trends Free-standing ERs & Micro-Hospitals • What are Micro-Hospitals? • lower acute issues • exam rooms • operating room • 8-10 beds • ancillary services • lab • radiology & imaging • pharmacy • sometimes primary care, dietary, women’s health, and outpatient surgery 12
Medical Lease Trends Free-standing ERs & Micro-Hospitals • On the rise • burgeoning model • fills gaps between UCC and hospital campus • cost effective • hospital affiliations • siting – 20 +/- miles from hospital campus • focus on User Experience • $15B in 2017 (4.1% growth) • 50-60 in pipeline • $7M-$50M construction 13
Medical Lease Trends Hospitals Transforming into Healthcare Systems • Expansion through UCC/ER; supplements physician acquisition model • Move to integrated health • shift in development design • digital • moving into communities • “Provider - based” rules 14
Medical Lease Trends Employers Entering the Healthcare Market • Will large corporate center leases start including medical space? • Amazon, J.P. Morgan Chase, and Berkshire Hathaway • Warren Buffet – healthcare spending is a “tapeworm of the U.S. economy” • 17.8% of GDP • Apple – HQs in Santa Clara County • AC Wellness (a group of health clinics for employees and families) 15
Medical Office Leases – Healthcare Regulatory Requirements
Fraud and Abuse Laws The Governing Laws – Federal (with State Corollaries) • The Physician Self-Referral Act t (S (Stark) (4 (42 U.S .S.C. . § 1395nn) • Example : Physician leases space to DHS entity above FMV and refer patients for DHS • Penalties : Fines up to $23,863 for each service, repayment of claims, and potential exclusion from all federal healthcare programs • The Anti-Kickback Statute (A (AKS) (4 (42 U.S .S.C. . § 1320a-7b(b)) • Example : Physician receives below FMV rent with intent to exchange lower rent for referrals • Penalties : Criminal fine (up to $100,000) and/or imprisonment (up to 10 years) Civil penalties ( up to $100,000 per violation + treble damages) Administrative penalties (exclusion from the Medicare and state healthcare programs) • Fals lse Cla laims Act t (F (FCA) (1 (18 U.S .S.C. . § 287 – cri riminal)(31 U.S .S.C. . § 3729 – § 3733 - civ ivil) • Example : Stark/AKS violation Renders all related claims false or fraudulent claims • Penalties : Treble damages suffered by government, plus up to $11,181 to $22,363 per claim 17
Stark Law • Prohibition: If a physician , or a member of the physician’s im immediate family, has a fi financial relationship ( including space lease ) with an entity, then the physician is prohibited from making a referral to the entity for the provision of designated health services (“DHS”) paid for by Medicare or Medicaid, and the entity is prohibited from billing for such service, unless an exception is satisfied • Stark is a strict liability statute (no intent requirement) • DHS: Clinical lab services, PT and occupational therapy, radiology and certain other imaging services (MRI, CT, ultrasound), radiation therapy and supplies, durable medical equipment and supplies, parenteral and enteral nutrients, equipment and supplies, prosthetics, orthotics, and prosthetic devices and supplies, home health services, outpatient prescription drugs, inpatient and outpatient hospital services 18
Anti-Kickback Law Prohibits anyone from knowingly and willfully offering, paying, soliciting, or receiving any remuneration in order to induce or reward referrals of items or services reimbursable by any federal healthcare program • Intent based (knowing and willful violation) • Not limited to physician, covers any healthcare provider participating in federal healthcare programs • Carries criminal, civil, and administrative penalties • Violation if just one purpose is to induce referrals, even if there are other legitimate business reasons for the payment 19
Stark and Anti-Kickback Law Exception and Safe Harbor: Overview • Stark: In order for a lease arrangement with a referral source to be compliant with the Stark law, the leasing arrangement must meet all elements of the applicable Stark law exception • AKS: While failure to comply with the applicable AKS safe harbor provision does not mean that a lease arrangement is per se illegal, to be protected by a safe harbor, an arrangement must fit squarely in the safe harbor 20
Elements of Stark Office Space Rental Exception Written rental or r le lease agreement, signed by the parties (does not have to be in one i. i. writing) Identify the specific premises rented (e.g., floor plan and square footage) ii. Agreement is at least one year in duration (and if terminating during the term, iii. parties are restricted from entering into a new agreement for the same space during the first year of the original term of the agreement) Space leased does not exceed th that which is is reasonable and necessary ry for le legitimate iv. business purposes of the lease Space (e.g., exam rooms, physician offices) must be used exclusively by Lessee v. Lessee may make payments for common area maintenance fees or charges only if vi. payments do not exceed lessee’s pro rata share of expenses for the space 21
Recommend
More recommend
