Building a Legally Compliant Referral Network

In order to survive, a pharmacy must establish a strong referral network. This can be accomplished by developing relationships with physicians, hospitals, long term care facilities and other referral sources. With the recent modifications to the federal physician self-referral statute (“Stark”) and the federal anti-kickback statute (“AKS”), CMS and the OIG are encouraging collaborative arrangements between providers with the twin goals of (i) making access to health care available to those who normally do not have such access and (ii) improving patient outcomes. At the same time, it is important that relationships with referral sources not “cross the line” to violating Stark, the AKS, and other applicable statutes. This program will discuss the federal anti-fraud laws that providers must follow, including Stark, the AKS, the False Claims Act, the beneficiary inducement statute, and The Travel Act. This program will also discuss examples of state anti-fraud laws and will then pivot to a discussion of the types of relationships that are legally permissible … and those that should be avoided. Examples of relationships to be discussed include (i) working with physicians in clinical studies; (ii) entering into Medical Director Agreements with physicians; (iii) sponsoring physicians as speakers; (iv) entering into preferred provider arrangements with hospitals and long-term care facilities; and (v) entering into joint ventures.