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Contract analysis / board-presentation-final-report-remediation-roadmap.pptx

board-presentation-final-report-remediation-roadmap.pptx

1010-00003 · 30 clauses

High · 1 Medium · 1 Standard · 3

1. Engagement Recap and Scope Summary

1. Engagement Recap and Scope Summary

2. Final Self-Assessment Findings — Risk Tier Summary

2. Final Self-Assessment Findings — Risk Tier Summary

3. High-Risk Arrangement Deep Dives (Meridian, Pinnacle, Medical Director Compensation, La

3. High-Risk Arrangement Deep Dives (Meridian, Pinnacle, Medical Director Compensation, Lakeview Legacy, ConnectiCare MSAs)

4. State Law Overlay — Massachusetts and Connecticut

4. State Law Overlay — Massachusetts and Connecticut

5. Voluntary Disclosure Evaluation — CMS SRDP and OIG SDP Conclusions

5. Voluntary Disclosure Evaluation — CMS SRDP and OIG SDP Conclusions

6. Completed Policy and Procedure Revisions

6. Completed Policy and Procedure Revisions

7. Contract Template Remediation Summary

7. Contract Template Remediation Summary

8. Third-Party Restructuring Status (Meridian Diagnostics, Pinnacle Laboratory)

8. Third-Party Restructuring Status (Meridian Diagnostics, Pinnacle Laboratory) 9. 90-Day Implementation Roadmap

10. Exit Readiness Considerations

10. Exit Readiness Considerations

11. Questions and Next Steps Medium

⚑ Notice / time limit to track

11. Questions and Next Steps [slide 3] Engagement Recap and Scope Engagement triggered by Compliance Committee review following Lakeview Medical Associates, P.C. acquisition (closed August 15, 2022; $11.4M asset purchase) Grayson Whitaker & Associates initial gap assessment (Report GW-AHT-2022-Final, December 12, 2022): identified 17 high-risk and 23 moderate-risk arrangements Calderwood & Harkness engaged January 30

1. Revised Compliance Program Manual — OIG Compliance Guidance (65 Fed. Reg. 59434); board

1. Revised Compliance Program Manual — OIG Compliance Guidance (65 Fed. Reg. 59434); board oversight; Compliance Committee structure; hotline protocols; investigation/disciplinary procedures; annual risk assessment

2. Revised Physician Compensation Policy — FMV and commercial reasonableness standards; ap

2. Revised Physician Compensation Policy — FMV and commercial reasonableness standards; approved benchmarks (Northbridge, MGMA, SullivanCotter); GC/CCO approval workflow; annual recertification; AHT medians: PCP $278K/yr, specialist $412K/yr

3. Revised Physician Referral and Self-Referral Policy — In-office ancillary services gove

3. Revised Physician Referral and Self-Referral Policy — In-office ancillary services governance; DHS tracking; Stark-compliant referral pathways for lab, imaging, and PT

4. Revised Vendor and Third-Party Arrangement Policy — AKS safe harbor checklists; approva

4. Revised Vendor and Third-Party Arrangement Policy — AKS safe harbor checklists; approval authority matrix; annual compliance reviews

5. Revised Gifts, Meals, and Entertainment Policy — Thresholds aligned with OIG guidance a Standard

⚑ Commercial term

5. Revised Gifts, Meals, and Entertainment Policy — Thresholds aligned with OIG guidance and Stark non-monetary remuneration exception ($459 CY2023 annual limit)

6. Fair Market Value Determination Procedures — Independent appraisal requirements; intern

6. Fair Market Value Determination Procedures — Independent appraisal requirements; internal benchmarking methodology; documentation retention; periodic refresh schedules

7. Non-Monetary Remuneration and Compliance Exception Tracking Protocol — Centralized trac Standard

⚑ Commercial term

7. Non-Monetary Remuneration and Compliance Exception Tracking Protocol — Centralized tracking log maintained by CCO; addresses items like the Pinnacle lab interface ($120K/year vs. $459 annual limit) [slide 14] Contract Template Remediation — Overview

1. Physician Employment Agreement — Stark-compliant compensation (base + wRVU within FMV);

1. Physician Employment Agreement — Stark-compliant compensation (base + wRVU within FMV); FMV certification clause; compliant term/renewal/holdover per 42 C.F.R. § 411.357(c); replaces all legacy AHT and Lakeview forms

2. IC/Medical Director Agreement — Fixed compensation (not variable with referrals); speci

2. IC/Medical Director Agreement — Fixed compensation (not variable with referrals); specified duties/hours; FMV certification; AKS personal services safe harbor representations; designed to cure the $501.28/hr effective rate issue

3. Office Space Lease — Conforms to Stark space rental exception (42 C.F.R. § 411.357(a))

3. Office Space Lease — Conforms to Stark space rental exception (42 C.F.R. § 411.357(a)) and AKS safe harbor (42 C.F.R. § 1001.952(b)); fixed term ≥1 year; FMV rent set in advance; not varying with referrals

4. Equipment Lease/Access Agreement — Conforms to Stark equipment rental exception and AKS

4. Equipment Lease/Access Agreement — Conforms to Stark equipment rental exception and AKS equipment rental safe harbor; fixed term; FMV rental; specified equipment

5. Management Services Agreement — AKS management contracts safe harbor language; Stark in Standard

⚑ Commercial term

5. Management Services Agreement — AKS management contracts safe harbor language; Stark indirect compensation safeguards; fixed-fee or blended model replacing percentage-of-revenue; for ConnectiCare-type arrangements

6. Meridian Diagnostics Restructured Facility Access Agreement (Draft) — Converts per-scan High

⚑ Penalty / liquidated damages

6. Meridian Diagnostics Restructured Facility Access Agreement (Draft) — Converts per-scan fee to fixed monthly FMV rental; 3-year term with annual FMV recertification; transmitted to Linden & Pryor LLP [slide 15] Third-Party Restructuring Status Meridian Diagnostics LLC: — Restructured draft facility access agreement transmitted to Linden & Pryor LLP (Thomas Beckett); proposed conversion from $185/scan variable fee

1. Board resolution adopting all 7 revised policies and procedures (target: next board mee

1. Board resolution adopting all 7 revised policies and procedures (target: next board meeting)

2. Derek Huang to initiate Phase 1 implementation plan and assign workstream owners

2. Derek Huang to initiate Phase 1 implementation plan and assign workstream owners

3. Patricia Yamamoto to authorize execution of revised Lakeview legacy agreements

3. Patricia Yamamoto to authorize execution of revised Lakeview legacy agreements

4. Derek Huang to follow up with Meridian Diagnostics / Linden & Pryor on restructured agr

4. Derek Huang to follow up with Meridian Diagnostics / Linden & Pryor on restructured agreement

5. Derek Huang to follow up with Pinnacle Laboratory on lab interface and CME restructurin

5. Derek Huang to follow up with Pinnacle Laboratory on lab interface and CME restructuring

6. Dr. Nathan Ellsworth to formalize conflict-of-interest disclosure regarding Dr. Karen E

6. Dr. Nathan Ellsworth to formalize conflict-of-interest disclosure regarding Dr. Karen Ellsworth's Pinnacle equity

7. Schedule mandatory compliance training rollout (all physicians and staff)

7. Schedule mandatory compliance training rollout (all physicians and staff) Calderwood & Harkness engagement formally closing July 12, 2023 — available for follow-up advisory as needed Contact: Miriam Calloway (mcalloway@calderwoodharkness.com) and Christopher Aiken (caiken@calderwoodharkness.com) — Calderwood & Harkness LLP, One Federal Street, 30th Floor, Boston, MA 02110