Anesthesia contract

Discussion in 'Anesthesiology' started by inquisitiveanes, Aug 9, 2015.

  1. inquisitiveanes

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    Recently I was told that dr x had the anesthesia contract at a hospital. This Dr X has been the main anesthesiologist there for more than a decade. This group has a constant turnover of anesthesia providers and the anesthesia providers working for him have been unhappy with workload, pay disclosures and opaque revenue collection and distribution.
    Anesthesiologists who have worked there for a long time went to the CEO of the hospital and complained about not being made full partners. They finally quit. Any way fresh graduates were recruited and soon they leave. But now I hear that Dr X has been withholding 3-6 months of their pay and not paying them for 3-6 months of work? Is this legal?
    In fact 3 anesthesiologists have made similar complaints? Is there any protection from this kind of fraud?
     
  2. IlDestriero

    IlDestriero Ether Man
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    This is the definition of a predatory group. A single partner, or a handful, are the true business partners and own the contract. They hire "equal partners" who are just employees and are never shown the books and never get fair profit sharing, share of the subsidy, etc.
    The CEO doesn't care about the employees of the group because the owner makes sure that all the work is done and the contract requirements are met.
    I've heard about this arrangement at a few small hospitals in desirable markets. You don't want anything to do with that place, other than maybe to try to bid for that contract when it's up for renewal.
    I don't know what the withholding pay is referring to, perhaps not paying them until the insurance companies pay the group for the work that they did. That shouldn't be an issue for an employee, that's a partner problem. An employee is hired to do x work for y pay.
    Dr. X is taking this predatory practice to the next level. I would bet this is in a hot saturated market or he'd be out of business.
     
  3. inquisitiveanes

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    Yes this is predatory practice. But is it legal to withhold collections and not pay when an employed physician is leaving the group. If the physician gives notice then he withholds 3 months of pay
    If not the. He withholds 6 months collections.
    Question is it legal to bill Medicare under someone else's npi and not pay that employer. Smells like Medicare fraud to me.
     
  4. Vandalia

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    It all depends on the specific terms of the contract. If the physician was technically an employee, in some states, there are laws from the 1920's that require an employee who quits/is fired to be paid the total amount due to them within 2 business days. As a general rule though, after any insurance provider pays a valid claim, they don't care what happens to the money after that point. My guess - see below - is that as long as there was no other fraud, the question is one of employment law, not insurance fraud.

    For 3-6 months pay it is probably worth contacting a local attorney. They are the only ones who can provide an answer to the question that is any more than a guess.
     
  5. SaltyDog

    SaltyDog Because my last Avatar was Deemed Inappropriate
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    Sure it's legal depending on how your contract with the group is written. The big mega group in town here (MD only) uses this method as their "non-compete" clause. If you voluntarily leave the group to go practice with another group in the same locality, the group keeps your AR's from the date you leave onward. Good way of keeping all the MD's in line and making sure nobody peels off and starts their own group as that would mean sacrificing a good 3-6mo. worth of pay.
     
  6. Mman

    Mman Senior Member
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    as mentioned above, it's a question of the terms of the employment contract and it's a matter of what the local laws are re: employment. It's not insurance fraud.
     
  7. urge

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    I don't see a problem with Dr X being the only person in control of the contract. The other guys are his employees. It's basically an AMC. The part about withholding their pay for 3-6 months sounds wearisome.

    Sounds like these anesthesiologists were hired with some, perhaps unfounded, expectation of making partner. Were they paid from day 1, and Dr X is just keeping the account receivable after they quit(which I think is ok) but for some weird reason the anestheiologists think they are entitled to it? Or, were they not paid for 3 months until their AR came in (in which case they are entitled to their AR)?

    Unless you have more info you cannot say if there is any fraud or not. Chances are you don't have the whole story.
     

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