Current Trends in Government Investigations and Enforcement Actions Concerning Medical Device Pricing and Reimbursement

Presentation details:

• Identifying fraud and abuse concerns in device coverage, pricing and reimbursement
  
• Avoiding anti-kickback violations for physicians and hospitals 
  
  
  
  • Stark Law implications


• Pinpointing scenarios where hospitals, physicians, and ASCs have been implicated for device reimbursement fraud by the government


• What are device manufacturers doing to prepare the sales force to speak to the government and private payors?
  
• Assessing the impact of the AdvaMed Code of Conduct on reimbursement and pricing protocols
  
• Exploring gain sharing concerns relative to pricing and reimbursement
  
  
  
  • common triggers for gain sharing investigations
    
  • adopting a preference for one medical device over another in order to get a larger volume discount when ordering the device
    
  • sharing savings between hospitals and doctors reviewing gain sharing program by the Inspector General’s Office at HHS