1. The U.S. Department of Justice (DOJ) collected $5.6 billion in False Claims Act recoveries in fiscal year (FY) 2021.

    That is over twice as much as 2020, and a record 90 percent of the total was collected from the health care and life sciences industries.

    DOJ’s health care recoveries in government-initiated actions were also more than double the total recoveries in actions initiated by whistleblowers.

    Health care enforcement targeted:

    ● billing for unnecessary medical services,
    ● solicitation or payment of kickbacks for goods or services paid for by federal health care programs, and
    ● risk adjustment fraud related to Medicare Advantage programs.

    The record-breaking year in FY 2021 shows that the pandemic has not weakened enforcement activity, especially for the health care and life sciences industries. Comprehensive and effective compliance is more important now than ever.

    To dive deeper into these stats and their impact on health care companies, read more from attorneys George Breen, Erica Sibley Bahnsen, Daniel Fundakowski, and Elizabeth Harris:

    Health Law Advisor: "DOJ Releases FY 2021 False Claims Act Recoveries: A Record-Shattering Year for Health Care and Life Sciences Enforcement, with Over $5 Billion Collected" - healthlawadvisor.com/2022/02/03/doj-releases-fy-2021-false-claims-act-recoveries-a-record-shattering-year-for-health-care-and-life-sciences-enforcement-with-over-5-billion-collected/

    Law360: “FCA Trends to Watch for Health, Life Sciences Companies” - ebglaw.com/insights/fca-trends-to-watch-for-health-life-sciences-cos/

    Learn more: ebglaw.com/trends-FCA21

    The Thought Leaders in Health Law® video series tracks the latest trends in multiple areas of the health care and life sciences industries, featuring attorneys and advisors from Epstein Becker Green and EBG Advisors.

    These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. THOUGHT LEADERS IN HEALTH LAW® is a registered trademark of Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.

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  2. Is your organization ready for the No Surprises Act (NSA)? The law goes into effect January 1, 2022, and contains a new federal ban on surprise billing as well as new disclosure requirements.

    The NSA applies to certain payors, providers, facilities, and ancillary service entities that support patients who receive emergency services or other non-emergency services at certain facilities, such as hospitals, hospital outpatient departments, and ambulatory surgical centers.

    What does this mean for you?

    • Health care businesses should design a detailed “operationalized” NSA compliance program now, but stay flexible as additional regulations are issued.
    • If you have operations in multiple states, assess whether state laws may apply and how they will interact with the federal law.
    • Calculate your median contracted rates for common services in each sector for billing guidance.
    • Ancillary service providers, in particular, must determine how to obtain the necessary information to help determine if federal protections apply to services they provide to patients in facilities in which they are not physically located.

    For more information on the NSA, visit: ebglaw.com/trending-issues/no-surprises-act/

    The Thought Leaders in Health Law® video series tracks the latest trends in multiple areas of the health care and life sciences industries, featuring attorneys and advisors from Epstein Becker Green and EBG Advisors.

    These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. THOUGHT LEADERS IN HEALTH LAW® is a registered trademark of Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.

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  3. A physician group should conduct extensive “reverse due diligence” before entering into a private equity (PE) partnership.

    Important things to consider include:
    - the PE firm’s financial ability to close the transaction with the physician group;
    - the physicians’ comfort level with the PE firm’s experience, integrity, culture, vision, and fit as a partner for the group;
    - and the PE partner’s specific experience and track record investing in physician services.

    You should speak directly with multiple physicians who have partnered with the investor in the past to assess all of these factors.

    Check out our other top considerations for physician groups evaluating PE.

    The Thought Leaders in Health Law® video series tracks the latest trends in multiple areas of the health care and life sciences industries, featuring attorneys and advisors from Epstein Becker Green and EBG Advisors.

    Visit ebglaw.com/thoughtleaders

    These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. THOUGHT LEADERS IN HEALTH LAW® is a registered trademark of Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.

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  4. Physician groups can keep their practice competitive–and on the “cutting edge”—by partnering with a private equity (PE) platform.

    The health care marketplace is evolving, and it takes substantial investment in infrastructure, such as IT, to stay ahead.

    A PE investor provides capital to acquire important strategic initiatives, like cutting-edge medical equipment and technologies, advanced electronic medical record capabilities, data analytics, new offices, and ancillary services.

    The PE investor’s existing corporate infrastructure may immediately provide some of these benefits.

    Stay tuned for more top considerations for physician groups evaluating PE.

    The Thought Leaders in Health Law® video series tracks the latest trends in multiple areas of the health care and life sciences industries, featuring attorneys and advisors from Epstein Becker Green and EBG Advisors.

    Visit ebglaw.com/thoughtleaders

    These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. THOUGHT LEADERS IN HEALTH LAW® is a registered trademark of Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.

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  5. A private equity (PE) transaction can give a physicians group more room to focus on clinical care as they relinquish much of the administrative and practice management duties. A PE partnership allows physicians access to the PE platform’s seasoned and sophisticated management team and capital.

    The team can provide managed-care contracting expertise, advanced electronic medical record capabilities, excellent billing and collection teams, financial management, HR executives, compliance staff, and more. Not only will significant cost savings be enjoyed, but operations will be improved and expanded.

    On the flipside, PE investors don’t want to tell physicians how to practice medicine. In fact, in many states, interference of that kind is illegal. PE investors will keep their focus on improving the business aspects of the practice.

    Stay tuned for more top considerations for physician groups evaluating PE.

    The Thought Leaders in Health Law® video series tracks the latest trends in multiple areas of the health care and life sciences industries, featuring attorneys and advisors from Epstein Becker Green and EBG Advisors.

    Visit ebglaw.com/thoughtleaders

    These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. THOUGHT LEADERS IN HEALTH LAW® is a registered trademark of Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.

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