Business Courtesy Policy

DEPARTMENT: Legal PAGE: 1 of 12 APPROVED: January 14, 2009 EFFECTIVE DATE: January 14, 2009
POLICY DESCRIPTION: Business Courtesies to Potential Referral Sources REPLACES POLICY DATED: December 2, 2008 RETIRED: REFERENCE NUMBER: LL.025
SCOPE: All Company-affiliated facilities, including without limitation, hospitals, ambulatory surgery centers, outpatient imaging centers, home health agencies, physician practices, service centers, imaging services and all Corporate Departments, Groups and Divisions. PURPOSE: To establish parameters for the extension of Business Courtesies to Potential Referral Sources or their Immediate Family Members. POLICY: On behalf of the Company, a Company or facility manager or employee may extend Business Courtesies, as defined and described below, to a Potential Referral Source or his/her Immediate Family Members as long as the total value of such Business Courtesies does not exceed $355 in calendar year 2009 or $338 in calendar year 2008, or any such higher amount in future calendar years as may be published and allowed by CMS pursuant to the linkage of such amounts to the Consumer Price Index (CPI). Nothing in this Policy permits any Business Courtesy or other benefit that is understood by either party to be offered or provided as an inducement to refer patients or business or as a reward for such referrals, nor may a Business Courtesy be extended to any Potential Referral Source or his or her Immediate Family Member who Solicits it or whose office staff Solicits it. Use of the Business Courtesies Log (the form of which is attached as Attachment A to this Policy) to track compliance with this $355 or $338 Annual Dollar Limit, as defined below (see further description of tracking in Section 2 of the Procedure Section of this Policy below), is the preferred method for tracking Business Courtesies to Potential Referral Sources and their Immediate Family Members. DEFINITIONS: Annual Dollar Limit: means $355 in calendar year 2009 and $338 in calendar year 2008, as such amount may be increased by CMS in future calendar years due to its linkage to the CPI, as explained above. Business Courtesies include gifts, entertainment, and off-site meetings where speakers, entertainment or food and drink are provided. They include items of value given to another free of cost, as well as social events sponsored or hosted by the Company such as meals, sporting events, theatrical events and receptions. Examples in the Procedure Section of this Policy further elaborate on what is and is not included in this definition. Notwithstanding the foregoing, for purposes of the Annual Dollar Limit, the Business Courtesies allowed under this Policy are expressly limited to the
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following specified types of items or services: 1. Meals (except if the meal qualifies under this Policy as a Modest Business/Service Meal); 2. Tickets for concerts, theatrical, sporting or charitable events; 3. Holiday or other parties or receptions sponsored by the facility (except for an event which qualifies as the Exempt Medical Staff Appreciation Event); 4. Food, drink or other perishables such as fruit or gift baskets; 5. Consumer goods (having a company or facility logo thereon) commonly given out by companies or facilities to their business associates, such as pens, shirts, hats and mugs; 6. Consumer goods given out in honor of a very special event such as a wedding or a major wedding anniversary; 7. Flowers; 8. Vouchers for perishables or services such as a spa service or haircut; 9. Fees to play golf, tennis or other sports; 10. CME sponsored by the facility or others or speaker costs at a professional event sponsored by the facility; and 11. Other similar types of items or services approved in writing in advance by a Company Regional Compliance Officer and by the Company Chief Compliance Officer by their joint execution of the Special Business Courtesy Approval Form attached to this Policy. Notes: Special Alcohol Warning. Company employees are strongly discouraged against ordering expensive wine or other alcohol at meals with physicians. Expensive wine or other alcohol will always disqualify a meal for the Modest Business/Service Meal category and often make it difficult for the cost of the meal to fit within the physicians Annual Dollar Limit. Special Raffle/Door Prize Warning. Since raffles or door prizes are uncertain as to their recipients and are often fairly substantial prizes, they are not suited by their nature to compliance with the Annual Dollar Limit. Thus, it is Company policy not to sponsor raffles or door prizes where physicians or their family members can be the winners of the raffle or door prizes. Exempt Medical Staff Appreciation Event means one local medical staff appreciation event per facility per calendar year which event must be for the entire medical staff, provided, however, (1) any gifts or gratuities provided in connection with such event are Business Courtesies subject to the Annual Dollar Limit; (2) only facilities with formal medical staffs qualify for this exemption; and (3) if the facility is part of a regional system (eg. Baptist Health System) where the multi-facilities are all
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part of one legal entity and have only one National Provider Identifier, then there must be only one such event during the calendar year because all of such facilities share one Annual Dollar Limit per calendar year. Immediate Family Member includes: husband or wife; natural or adoptive parent, child, or sibling; stepparent, stepchild, stepbrother, or stepsister; father-in-law, mother-in-law, son-in-law, daughter-inlaw, brother-in-law, or sister-in-law; grandparent or grandchild; and spouse of a grandparent or grandchild. Modest Business/Service Meals means modest business meals in connection with (i) a business meeting of the facilitys Board of Directors, Board of Trustees, medical executive or other facility committee or (ii) a business meeting between a member of facility administration and a Potential Referral Source or his/her Immediate Family Member who is performing services for the facility at such meeting. Modest means that the meal is not of substantial value, is not lavish, could be reasonably described as modest as such term is commonly used and occurs in a venue and manner conducive to conducting the business of the Board, committee or facility administration. Also, the substantive business component of the meeting must be the predominate reason for the meeting and, if the meal is with a member of facility administration, it needs to relate to services reasonably needed by the facility or other facility business, and cannot at all relate to referrals for new, increased or continued admissions to the facility from the Potential Referral Source or be celebratory in nature. If there is any doubt by the facility manager regarding whether a meal qualifies as a Modest Business/Service Meal under this definition and the examples set forth below, then the meal should not be considered by the facility a Modest Business/Service Meal, but rather a normal Business Courtesy subject to the limits of this Policy. In order to qualify a meal as a Modest Business/Service Meal, a Company employee attending the meal must fill out and have executed by all participants at the meal the Modest Business Meal Letter (in the form attached hereto). A Company employee must attach the letter to his/her Company expense account relating to reimbursement to the employee of the costs of the meal. In addition to the above requirements, (a) no spouses or guests may attend a Modest Business/Service Meal and (b) without Regional Compliance Officer or Chief Compliance Officer approval, no per-physician allocation of meal costs from a Modest Business/Service Meal may exceed $75 (ie, normally meal costs in excess of $75 each cannot qualify for the Modest Business/Service Meal category). Potential Referral Source includes: a doctor of medicine or osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine, a doctor of optometry, or a doctor of chiropractics. It does not include any such doctors who do not provide clinical care or order tests (e.g., physicians who provide non-clinical consulting or other leadership services to a Vanguardaffiliated entity and do not provide clinical services); nor does it include any such doctors employed
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by Vanguard-affiliated entities receiving Business Courtesies from their Vanguard entity employer. Solicit means to request or ask for a business courtesy. It does not include a situation in which a physician asks for something that is commonly known to be available (e.g., tickets to a sporting event on a particular night, when it is known the facility has season tickets generally available). PROCEDURE: 1. A Company manager or employee may extend a Business Courtesy to a Potential Referral Source and his or her Immediate Family Members only under the following conditions: a. It is not cash or a cash equivalent (e.g., gift certificates, checks or stock instruments) and it is not a Business Courtesy given as a prize in a raffle or as a door prize. Vouchers that may be exchanged only for a particular item or service (e.g., a voucher for a ham or a massage) are not considered a cash equivalent; It does not exceed the Annual Dollar Limit in value or cause the total value of Business Courtesies extended to the same Potential Referral Source and his or her Immediate Family Members to exceed the Annual Dollar Limit; It is not determined in any manner that takes into account the volume or value of referrals or other business generated by the Potential Referral Source; It is not Solicited by the Potential Referral Source or his/her office staff members; and If it is to be part of the Annual Dollar Limit in respect of any Potential Referral Source, it is limited to one of the categories of Business Courtesies listed in Subsections 1 through 11 of the definition of Business Courtesies set forth above.
b.
c. d. e.
2.
The facility must establish a tracking mechanism to show compliance with the Annual Dollar Limit. A tracking schedule entitled Business Courtesies Log has been attached as Attachment A to this Policy. The Company facility must fill out this Log (or an equivalent schedule) if it extends any Business Courtesies to Potential Referral Sources or their Immediate Family Members that are of the type that are included within the Annual Dollar Limit. Facilities should note that such Log may be requested at any time by the Companys Legal, Compliance or Internal Audit Departments to insure the facilitys compliance with such Annual Dollar Limit. The Companys Divisions, Group and Corporate Departments and entities will not maintain Business Courtesies Logs. If a Company Division, Group or Corporate Department or entity provides a benefit which would otherwise fall within the definition above of a
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Business Courtesy to a Potential Referral Source to the sole benefit of a single facility, then the value of the item should be allocated in whole to that facility. If a Company Division, Group or Corporate Department or entity provides a benefit which would otherwise fall within the definition above of a Business Courtesy to a Potential Referral Source to the benefit of a number of facilities, then the value of the item should be allocated evenly to such facilities, usually hospitals, where the individual is a Potential Referral Source. Where one legal entity owns separate facilities, there is one Annual Dollar Limit unless (1) the facilities are separately licensed and (2) the facilities have its own National Provider Identifier (NPI), in which case each such facility would then have its own separate Annual Dollar Limit amount to utilize in respect of its own Business Courtesies. 3. Examples of Business Courtesies that ARE within the Annual Dollar Limit and must be tracked include: a. a special celebratory dinner at a restaurant for Potential Referral Sources and their spouses to recognize Potential Referral Sources when annual mortality data is released; a dinner at a restaurant to market a Company facility to a Potential Referral Source; a dinner at a restaurant or administrators home to celebrate a milestone for the facility such as the end of a project or the launch of a new service; paying the greens or entry fees for a Potential Referral Source or his or her Immediate Family Members for golf (whether one-on-one or for a charity or facility golf tournament); providing tickets for Potential Referral Sources and/or their Immediate Family Members to sporting or theatrical (or similar) events; sending perishable items (e.g., fruit basket or other food items) to a Potential Referral Sources office when it is anticipated that the Potential Referral Source will share in the enjoyment of the items or when it is known that the Potential Referral Source actually shared in the items although he was not anticipated to do so. The value to each Potential Referral Source in the practice is the total cost of the item divided by the number of persons who will enjoy the benefit of the items (i.e., total number of Potential Referral Sources and employees in the practice) and no such calculation need be made when the items are enjoyed solely by the office staff; providing flowers or other gifts to Potential Referral Sources or their Immediate Family Members when they are hospitalized or to recognize a
b. c. d.
e. f.
g.
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h.
i.
j. k.
birthday or other family occasion; paying for a Potential Referral Sources CME program costs (unless (1) such costs are to be paid for pursuant to a written personal services agreement, (2) otherwise fall within an exception set forth in the Non-Employed Physician Education Expenses Policy, LL.010, or (3) relate to a program where compliance training is the primary purpose of the training). (See the General Statement on Agreements with Referral Sources, Approval Process Policy, LL.001, the Professional Services Agreements Policy, LL.002, and the NonEmployed Physician Education Expenses Policy, LL.010.); hosting holiday or other parties for medical staff members and their spouses (except for an event which qualifies as the Exempt Medical Staff Appreciation Event); hosting or providing food, drink, speakers or entertainment at gatherings of Potential Referral Sources; and a dinner at a restaurant to recruit an in-market physician (a Potential Referral Source) to the hospitals medical staff where the physician does not qualify under the Stark law or regulations for an income guarantee by the facility.
4.
The following activities are NOT considered Business Courtesies and may be provided to Potential Referral Sources. Because they are not considered Business Courtesies, they do not count toward the Annual Dollar Limit for Business Courtesies and do not need to be tracked. Specifically, a facility may: a. confer on Potential Referral Sources who are members of the medical staff benefits valued at less than $30 per occurrence in calendar year 2009 or $29 per occurrence in calendar year 2008 (or such higher per occurrence amount as may be published by CMS for future calendar years, in the same manner as the CPI increase in the Annual Dollar Limit as explained above) and which occur on the campus of a hospital or other Company facility campus provided: 1) except with respect to identification of medical staff on a facility Web site or mere identification in hospital advertising, the benefits are offered only during periods when the Potential Referral Source is making rounds or engaged in other services or activities that benefit the facility or its patients; all members of the medical staff practicing the same specialty are offered the same benefit; the benefit is reasonably related to the provision of, or designed to
2) 3)
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4)
facilitate directly or indirectly the delivery of, medical services at the facility; and the benefit is not determined in any manner that takes into account the volume or value of referrals or other business generated between the parties.
b. c.
d.
e.
f.
Examples of this exception (commonly called the Medical Staff Incidental Benefits Exception) include lab coats, free parking in the facilitys garage or a meal valued at less than $30 each in 2009 or $29 in 2008 (as such amount may be increased by CMS) in the physicians lounge or hosting a reception at the facility to introduce the medical staff to the facilitys new CEO. The on campus requirement is deemed satisfied by internet access, pagers, or twoway radios used away from the campus only to access facility medical records or information or personnel who are on the campus; provide items in exchange for payment by the Potential Referral Source of their fair market value price; modest meals provided in connection with business meetings of the Board of Trustees, medical executive committee or other facility committees, because these types of meals qualify as Modest Business/Service Meals, as this term is defined above; a modest meal provided to a physician on the medical staff of a hospital at a dinner with a member of hospital administration to meet and/or help recruit a physician to relocate his or her medical practice to the geographic area served by the hospital in order to become a member of the hospitals medical staff, because this type of meal qualifies as a Modest Business/Service Meal, as this term is defined above; pursuant to a professional services agreement, pay or reimburse reasonable business expenses related to the purchased services, or provide a modest meal incident to a business meeting with a Potential Referral Source to discuss issues relating to a department of the facility for which the Potential Referral Source is the medical director, because this type of meal qualifies as a Modest Business/Service Meal, as this term is defined above (See also the General Statement on Agreements with Referral Sources, Approval Process Policy, LL.001, and the Professional Services Agreements Policy, LL.002.); pursuant to an appointment letter in which the Potential Referral Source has agreed in writing to receive such reimbursement in exchange for his or her volunteer Board or committee services to the facility or unpaid medical directorship services to the facility (form of appointment letter
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attached), Company facilities may pay or reimburse in a manner consistent with the Companys travel policies the reasonable expenses of Potential Referral Sources and their spouses or guests incident to the Potential Referral Sources attendance at and participation in facility-sponsored events, such as Board or medical executive committee retreats, or to attend conferences relevant to the performance of their leadership responsibilities provided such events or retreats must meet the following conditions: 1) the event or retreat is not held at a hotel, resort or other building located more than 500 miles from the Company facility and the event or retreat is held within the continental United States (unless approved by the Senior Vice President Compliance & Ethics); the event or retreat is not or does not appear to be lavish or extravagant; the event or retreat will not occur on a mode of transportation (e.g., cruise ship) unless approved by the Senior Vice President Compliance & Ethics; the substantive component of the event or retreat predominates over any entertainment or recreational activities; services performed pursuant to the appointment letter must be tracked. This may be accomplished by collecting and retaining meeting sign-in sheets or minutes, assuming such documents indicate the duration of the meeting; time sheets; or other writings that evidence the time the Potential Referral Source has performed pursuant to the appointment letter; The cost of Business Courtesies provided at the event (for example, Business Courtesies at a retreat would not be normal expenses of the physician in attending the retreat like his/her transportation expenses, hotel expenses and business meals held in conjunction with business sessions of the retreat, but would be non-business meals provided at the retreat (like evening dinners during which no retreat business was conducted), or cocktail receptions, hotel costs for additional nights before or after the retreat, travel costs for the spouse or other guest of the physician at the retreat, entertainment and recreation costs at the retreat, gifts delivered at the retreat, etc.) must be tracked by the facility and may not exceed the fair market value of the physicians total uncompensated time expended by the physician throughout the period prior to the event or retreat and booked in the physicians
2) 3)
4) 5)
6)
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Business Courtesy Log plus the unused amount of the physicians Annual Dollar Limit plus an estimate of the compensation to be earned by the physician by attending the business sessions of the event, if any; and, in addition, the total amount of remuneration which the facility may provide at the event or retreat shall be calculated in conformity with the following example: Example: A physician serves on the facilitys MEC and is not compensated for such service. The physician has entered into an appointment letter with the facility. The facility has determined pursuant to a tracking mechanism that the physician has spent prior to the retreat 10 hours in MEC meetings which are booked in the Physicians Business Courtesy Log as showing a credit of $1,500 (10 times $150). Prior to the retreat, the facility has not provided the physician any Business Courtesies during the current calendar year which have used up any of this $1,500 credit or any of the Annual Dollar Limit ($355 in 2009). The facility wants to sponsor a MEC retreat at a resort a few hours from the facility but not more that 500 miles from the facility, the substantive component of the retreat will be 6 hours of official sessions in aggregate time and the facility will not have arranged that any of the substantive component of the retreat will entitle the physician to CME credit (if such CME credit has been arranged, then any CME hours cannot be counted as uncompensated physician services for the MEC). If the fair market value of the physicians time is $150 per hour, then the total amount the facility may spend on this particular physician and his or her spouse or guest at the retreat is $2,400 plus $355 in 2009 for the Annual Dollar Limit or a total of $2,755 (16 hours times $150 for $2,400 plus $355 for the Annual Dollar Limit in 2009) for Business Courtesies provided at the retreat; provided that the facility has not arranged for any of the 6 hours of official sessions to constitute CME for the physician. Please note that if any of the hours have been arranged to be CME any such CME hours cannot accrue to the physician for the purposes of this calculation (e.g., in the example above if 3 hours have been arranged to be CME, then the total amount the facility may spend on this particular physician and his or her spouse or guest at the retreat is $1,950 plus $355 for the Annual Dollar Limit or a total of $2,305 (13 times $150 or $1,950 plus $355 for the Annual Dollar Limit in 2009) for Business
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Courtesies provided at the retreat which in this case should also include the cost of the CME provided).
g.
h.
i.
j. k.
l.
provide a computer or other technology wholly dedicated to use in connection with a facilitys services to patients which is solely for the hospitals benefit and convenience; provide transcription of hospital medical records dictated by a staff physician (but not of the physicians private office records, which would be compensation to the physician); provide compliance training (which may include the basic elements of a compliance program, or the requirements of the Federal healthcare programs such as billing and coding or the requirements of applicable laws or regulations) to a physician or his/her office staff, if the training is held in the local community or service area and does not include CME credit for the physician, provided, however, notwithstanding the foregoing, commencing December 4, 2007, such training may included CME credit for the physician as long as the compliance training is the primary purpose of the training; an Exempt Medical Staff Appreciation Event; extend professional courtesy discounts consistent with the Professional Courtesy Discount Policy, LL.018, and any facility policy adopted pursuant thereto; and other modest meals to Potential Referral Sources and their Immediate Family Members which constitute Modest Business/Service Meals under the definition of Modest Business/Service Meals which is set forth above.
5.
The following are also NOT considered Business Courtesies. a. An administrator who has become friends with a Potential Referral Source and/or Immediate Family Member and who socializes with such individual(s) may personally pay for the cost of social events, provided the administrator does not include this item as a business expense for tax purposes and does not charge the facility or otherwise receive reimbursement from the facility to cover this expense. A Potential Referral Source who is also the spouse of a facility administrator may attend facility social events in his or her capacity as the administrators spouse and such events do not count toward the Annual Dollar Limit for Business Courtesies and do not need to be tracked.
b.
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DEPARTMENT: Legal PAGE: 11 of 12 APPROVED: January 14, 2009 EFFECTIVE DATE: January 14, 2009 6.
There is now a limited opportunity to cure violations of the Annual Dollar Limit provided the Company creates a Business Courtesies Watch List related to physicians who have cured the violations. a. Business Courtesies in excess of the Annual Dollar Limit may be cured and not constitute violations of the Stark Act only if (1) the overage is no greater than 50% of the then Annual Dollar Limit; (2) the overage was inadvertent; (3) the physician repays the facility the excess over the Annual Dollar Limit by the earlier of (a) the end of the calendar year in which the physician received it or (b) 180 days from the date that the physician received it; and (4) the physician has not had overages cured pursuant to these provisions more than once every three years. For example, if a physician received $350 worth of Business Courtesies in 2007 which was repaid prior to the end of 2007 and $400 in 2008, this cure provision could not be used to cure the 2008 overage since there was an overage also in 2007 and that 2007 overage was within three years. The Companys Regional Compliance Officers (or other designee of the Companys General Counsel) shall assemble a list or list(s) of physicians who have exceeded the Annual Dollar Limit for any calendar year (eg, received Business Courtesies in 2008 in any amount in excess of $338) and have cured the overage by paying the Company back the overage by the earlier of (a) 180 days from receipt of the overage and (b) December 31 of the year of the overage. The Watch List shall be routed monthly or quarterly to the appropriate Company employees in the region in which the physician practices medicine and to the Companys Corporate Legal, Compliance, Office of the COO and Development Departments. Physicians whose names are set forth on the Watch List shall stay on such List for two full calendar years after the calendar year in which the physician has the overage. Once a physician is listed on the Watch List, all additional Business Courtesies granted to such physician while he or she is on the Watch List must be pre-approved by the relevant Regional Compliance Officer or the Chief Compliance Officer.
b.
7.
The Company employee providing the Business Courtesy to the physician should log in the amount of the Business Courtesy on the Companys relevant Business Courtesy Log during the next business day after the Business Courtesy was granted. A copy of the Company employee expense report showing each Business Courtesy provided to a physician or other Potential Referral Source must be provided to the relevant
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Regional Compliance Officer as soon as practicable after the date of the receipt of the Business Courtesy. The Regional Compliance Officer will then compare the expense report entry to the prior entry on the Business Courtesy Log and adjust/enter as appropriate. 8. Company-affiliated facilities should record Business Courtesies in GL Account No. 580.01 since some of these amounts must be excluded from the Medicare cost reports. Each Company-affiliated facilitys CEO is responsible for overseeing implementation of this policy.
9.
REFERENCES: 42 U.S.C. 1320a-7b; 42 U.S.C. 1001.952(a)-(a); 42 U.S.C. 1395 nn; 66 Fed. Reg. 856, 961-962 (January 4, 2001); 69 Fed. Reg. 16054 (March 26, 2004); 72 Fed. Reg. 51012 (Sept. 5, 2007) General Statement on Agreements with Referral Sources, Approval Process Policy, LL.001 Professional Services Agreements Policy, LL.002 Non-Employed Physician Education Expenses Policy, LL.010 Professional Courtesy Discount Policy, LL.018 American Hospital Associations letter dated December 3, 2001 to the Centers for Medicare and Medicaid Services: www.hospitalconnect.com/aha/advocacygrassroots/advocacy/legal/LtrStarkB1218.html
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BUSINESS COURTESIES LOG FACILITY NAME: CALENDAR YEAR ENDED:

PHYSICIAN NAME NAME OF OTHER RECIPIENT / IMMEDIATE FAMILY MEMBER DESCRIPTION OF BENEFIT DATE OF BENEFIT
ATTACHMENT A
VALUE OF BENEFIT
Attachment for LL.025
SAMPLE APPOINTMENT LETTER IMPORTANT NOTE: ONCE EXECUTED, THE FACILITY MUST SEND A COPY OF THE EXECUTED APPOINTMENT LETTER TO CORPORATE TO BE ENTERED INTO THE COMPANYS CONTRAXX PHYSICIAN CONTRACT MANAGEMENT SYSTEM. IF YOU MAKE ANY CHANGES TO THIS FORM APPOINTMENT LETTER, YOU MUST EITHER CONTACT A CORPORATE LEGAL OPERATIONS ATTORNEY FOR PRIOR APPROVAL OF THE CHANGE OR PROCESS THE APPOINTMENT LETTER THROUGH THE CONTRAXX SYSTEM FOR APPROVAL OF THE PROPOSED CHANGES BEFORE EXECUTION. (date)
Physician Name Address City, State, Zip
Dear Dr.
I am pleased to confirm your appointment as a member of the [Choose one of following: Board of Trustees, Medical Executive Committee, or name of other committee of the Hospital which has been established by the Board of Trustees or MEC] [(Board)] [(Committee)] of _________________ Hospital (Hospital) for the period of , 20 to , 20 . This letter is to serve as a formal appointment agreement (Letter Agreement) with the Hospital. We appreciate your willingness to serve in this important role. In consideration for your time spent [preparing for and] [SINCE THIS MAY BE HARD TO ACCURATELY TRACK, THE BRACKETED LANGUAGE MAY BE DELETED IF DESIRED] attending [Board][Committee] meetings and other sessions [and in conducting [Board] [Committee] business] [AGAIN, SINCE THIS MAY TO HARD TO ACCURATELY TRACK, THE BRACKETED LANGUAGE MAY BE DELETED IF DESIRED], the Hospital agrees to pay for the following expenses associated with your service on the [Board][Committee]: all reasonable out-of-pocket expenses associated with [Committee][Board] activities, including the cost of meals served at business meetings of the [Committee][Board]; the costs associated with your attendance at [Committee][Board] retreats; the costs of educational conferences that you are requested to attend in connection with your [Committee][Board] duties; and any other reasonable costs associated with your role on the [Committee][Board];
provided, such expenses are consistent with the Hospitals policies and have been pre-approved by the Hospital. In addition, in Hospitals sole discretion and in further consideration of your time and efforts in conducting [Committee][Board] business, we may invite you and your spouse to a non-business meal, social event, entertainment event or activity or invite your spouse to a retreat as a token of appreciation for your services on the [Committee][Board] (Business Courtesies). For purposes of determining your entitlement to the Business Courtesies and to all [Committee][Board] related expenses which are considered remuneration to you under the Stark law and regulations, we will value your time in performing [Committee][Board] business for Hospital at [$______ per hour NOTE: A SPECIFIC
Attachment for LL.025 1
HOURLY FAIR MARKET RATE MUST BE INSERTED, BUT DO NOT INSERT A RATE IN EXCESS OF $150]. In order to comply with the Stark law and regulations requiring signed written documentation of various types of physician remuneration, we ask that you evidence your agreement to serve on the [Committee][Board] by executing this Letter Agreement below. As part of this Letter Agreement, you represent and warrant to us that you are not currently excluded, suspended, debarred or otherwise ineligible to participate in Federal health care programs. Additionally, by signing below both the Hospital and you agree that: any payments made by the Hospital hereunder which are considered to be remuneration to you under the Stark law or regulations are, and will be, fair market value for the services provided by you to the Hospital under this Letter Agreement. nothing contained herein is intended to induce you, and nothing herein requires you, to refer or admit patients to, or order any goods or services from, the Hospital. notwithstanding any unanticipated effect of any provision of this Letter Agreement, neither party will knowingly or intentionally conduct himself/herself/itself in a manner as to violate the prohibition against fraud and abuse in connection with the Medicare and Medicaid programs (42 USC 1320a-7b).
The Hospital and its affiliates maintain and update a master list of contracts centrally that is available for review by the Secretary of Health and Human Services upon request. We appreciate your executing this Letter Agreement in the space provided below and returning it to us. We will retain the original for our records and will forward a copy to you for your files.
_____________________________ d/b/a________________HOSPITAL
PHYSICIAN
By: Hospital CEO (signature) Date:
(signature)
(print name) Date:
Attachment for LL.025 2
SPECIAL BUSINESS COURTESY APPROVAL FORM
TO: [INSERT NAME OF REGIONAL COMPLIANCE OFFICER] BRUCE CHAFIN, VANGUARD CHIEF COMPLIANCE OFFICER FROM: RE: REQUEST FOR APPROVAL OF NON-CONFORMING BUSINESS COURTESY DATE:
I WISH TO GIVE TO _________________________________________WHO PRACTICES AS A ___________________________TYPE OF PHYSICIAN [INSERT NAME OF PHYSICIAN AND HIS/HER SPECIALTY ON THE FOREGOING TWO LINES] THE FOLLOWING BUSINESS COURTESY AND COUNT IT AS PART OF SUCH PHYSICIANS ANNUAL DOLLAR LIMIT FOR THIS CALENDAR YEAR, EVEN THOUGH THIS TYPE OF BUSINESS COURTESY IS NOT LISTED IN SUBSECTIONS 1 THROUGH 10 OF THE LIST OF PERMITTED BUSINESS COURTESIES SET FORTH IN THE DEFINITION OF BUSINESS COURTESIES IN LEGAL DEPARTMENT POLICY LL.025:
THE SPECIFIC REASON(S) I WISH TO GIVE THIS TYPE OF BUSINESS COURTESY ARE AS FOLLOWS:
IF YOU APPROVE OF THIS ACTION, PLEASE EXECUTE THIS FORM AND SEND IT BACK TO ME AS SOON AS PRACTICABLE.
THE FOREGOING IS APPROVED:
______________________________ REGIONAL COMPLIANCE OFFICER
DATE:____________________
_______________________________ CHIEF COMPLIANCE OFFICER
DATE:_____________________
MODEST BUSINESS MEAL LETTER
The undersigned affirm the following: 1. _______________________Hospital is today providing the undersigned physician(s) with a modest business meal at ____________________Restaurant in City of ______________, State of _________________incident to a business meeting with the undersigned physician(s) deemed necessary by the Hospital to discuss issues directly relating to the Hospitals business operations. The business Agenda of the meeting is solely as follows: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ There will be no discussions at the meal related to encouraging continued, increased or new medical referrals from the participating physician(s) to the Hospital or its affiliated entities and in no event is the meal celebratory or social in nature. SIGNATURE(S) OF PHYSICIAN PARTICIPANTS ___________________________ ___________________________ ___________________________ ___________________________
2.
3.
SIGNATURE(S) OF HOSPITAL PARTICIPANTS ________________________ ________________________ ________________________ ________________________
DATE:____________________, 200__

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DEPARTMENT: Legal PAGE: 1 of 12 APPROVED: January 14, 2009 EFFECTIVE DATE: January 14, 2009

BUSINESS COURTESIES LOG FACILITY NAME: CALENDAR YEAR ENDED:

Attachment for LL.025

Physician Name Address City, State, Zip

Attachment for LL.025 1

By: Hospital CEO (signature) Date:

(print name) Date:

Attachment for LL.025 2

SPECIAL BUSINESS COURTESY APPROVAL FORM

THE FOREGOING IS APPROVED:

______________________________ REGIONAL COMPLIANCE OFFICER

_______________________________ CHIEF COMPLIANCE OFFICER

Attachment for LL.025

MODEST BUSINESS MEAL LETTER

SIGNATURE(S) OF HOSPITAL PARTICIPANTS

Attachment for LL.025

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