Source: http://www.tmajcr.org/journalofcorporaterenewal/april_2015?pg=17
Timestamp: 2019-04-26 02:04:09+00:00

Document:
Shawn M. Riley heads the Cleveland office of McDonald Hopkins and founded the firm’s Business Restructuring Services Department.
For over 25 years, he has advised businesses in a number of industries ranging in size from $10 million in revenue to multibillion dollar public companies on strategic alternatives, including acquisitions, sales, mergers, affiliations, refinancing, recapitalizations, and restructurings. In the healthcare industry, Riley has advised community and rural hospitals and long-term care facilities.
Although resident in the Cleveland office, his clients are located throughout the eastern U.S.
Rick Hindmand focuses his practice at McDonald Hopkins on healthcare regulatory, data privacy, cybersecurity, corporate, and transactional matters.
He represents physicians and other healthcare providers and organizations in structuring group practices, joint ventures, medical device companies, ambulatory surgery centers, provider networks, and ancillary services, as well as physician/hospital alignment strategies and involvement in accountable care organizations (ACOs). Hindmand’s services extend to various corporate and transactional matters, including practice acquisitions and managed care, billing, management, employment, independent contractor, and other service arrangements.
1 See, Carol K. Kane, PhD, and David W.
Emmons, PhD, “New Data on Physician Practice Arrangements: Private Practice Remains Strong Despite Shifts Toward Hospital Employment,” (2013).
2 Medicare pays more for various physician and ancillary services when performed in a HOPD than in a freestanding physician office. This “provider-based” reimbursement differential offers a financial incentive for health systems to acquire physician practices. It typically allows for increased compensation to physicians, particularly if physician compensation is related to collection for the physician’s personally performed services. This differential can apply even if the same physician furnishes the same services to the same patient within the same office, and typically increases the patient copayment.
4 42 U.S.C. § 1395nn.
5 42 U.S.C. § 1320a-7b(b).
6 31 U.S.C. § 3729-3731.
7 42 C.F.R. § 411.351 (“designated health services” defined).
8 “Federal health care program” includes a broad range of federally funded healthcare programs, including Medicare and Medicaid. See 42 U.S.C. § 1320a-7b(f).
9 U. S. ex rel Drakeford v. Tuomey, 976 F.Supp.2d 776 (D.S.C. 2013).
10 In March 2014, Halifax Hospital Medical Center and its affiliated staffing company agreed to pay the federal government $85 million and enter into a corporate integrity agreement to settle allegations of improper billing for services referred by six oncologists and three neurosurgeons. The government claimed that the compensation packages were excessive or varied based on referrals and therefore failed to satisfy any exception under the Stark Law, thereby causing all related billings by Halifax to violate the False Claims Act. In November 2013, the court ruled in favor of the government's position that Halifax's incentive bonus formula violated the Stark Law, because any one of the oncologists could increase the size of the bonus pool by simply making more referrals, thereby increasing his or her bonus based on those referrals.
11 42 U.S.C. § 1320a-7k(d).
12 42 C.F.R. § 411.357(f).
13 42 C.F.R. § 411.357(f).

References: § 1395
 § 1320
 § 3729
 § 411
 § 1320
 v. 
 § 1320
 § 411
 § 411