FMV Under the Microscope: Protecting Your Hospital in a $6.5B Enforcement Environment

With OIG collections reaching record highs in 2025, regulatory scrutiny around provider compensation has intensified. For rural hospitals operating on thin margins, even small missteps in Fair Market Value (FMV) determinations can carry outsized financial and reputational consequences.

This session will demystify the intersection of FMV, the Stark Law, and the Anti-Kickback Statute — translating complex federal statutes into clear governance and operational guardrails. Rather than focusing solely on risk avoidance, we will outline practical, proactive strategies that allow hospitals to remain competitive in physician recruitment while maintaining regulatory safety.

Attendees will explore real-world compensation scenarios, learn how enforcement trends are evolving, and understand how structured “safety valve” approaches — such as defined base compensation buffers and documentation best practices — can create defensible positioning in an increasingly scrutinized environment.

Joe Theine, CEO of Southwest Health System in Colorado, will share his perspective on how rural leadership teams can balance competitive recruitment pressures with regulatory discipline, offering practical insights from his organization’s experience.

This session is designed for board members, executives, and legal leaders who want to move from reactive compliance to strategic risk management.

At the end of this session, participants will be able to:

  • Explain the regulatory interplay between FMV, the Stark Law, and the Anti-Kickback Statute in a way that supports board-level oversight and governance.
  • Identify compensation structures and documentation practices that reduce enforcement risk while maintaining market competitiveness.
  • Implement practical guardrails and “safety valve” strategies to ensure compensation plans remain defensible in a heightened enforcement climate.
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Q&A

How do people stay on top of all the payer newsletters to sort through everything to pull out applicable information for the facility/provider? Who typically is going through the newsletter to gather the information to share with other staff?

Our billing specialists are organized by payer, allowing them to develop deep expertise in their respective areas. Each specialist subscribes to their payer’s newsletters to stay informed about updates and changes. Additionally, our team leads, Supervisor, and Director of Patient Accounts—along with the Prior Authorization Team—collaborate to share key insights and ensure the entire team stays up to date. This collective approach enhances our ability to navigate payer policies efficiently and provide the best possible service. 

What leadership structure do you have in place for your revenue cycle and who or what do you use for training when billers or coders need it? Especially for new service lines or common denials?

Our billing specialists are supported by a structured leadership team, including two team leads, one Supervisor, and one Director. Training for billing specialists is conducted by our Supervisor and team leads to ensure consistency and expertise. Additionally, billing specialists meet weekly with leadership to review denials and identify payer-specific trends. For new coders, who are required to be certified, training is led by our Coding Lead to maintain high standards of accuracy and compliance.

Are the billers assigned based on an alphabetical split or by insurance type, such as Medicare and Medicaid specialists?

Billers are first assigned by insurance type and then further divided by alphabetical split. Since each insurance type has multiple billers, the alpha split helps distribute the workload efficiently.

Since we have union employees, how could we implement a similar incentive to Kindal’s while ensuring compliance with union regulations?

This would depend on the specifics of your union contract. Stroudwater can work with you to review the contract and develop a compliant incentive model.

Does your Coding/HIM department manage CPT coding, modifiers, and ICD-10, or do they focus solely on ICD-10?

Our Coding team handles all aspects of coding, including CPT, modifiers, and ICD-10. They thoroughly review all provider documentation to ensure accuracy and compliance.